masterarbeit / master’s thesisothes.univie.ac.at/43078/1/45104.pdf · thuy thanh truc pham, bsc...
TRANSCRIPT
MASTERARBEIT / MASTER’S THESIS
Titel der Masterarbeit / Title of the Master‘s Thesis
„The diet of Vietnamese immigrants in Austria“
verfasst von / submitted by
Thuy Thanh Truc Pham, BSc
angestrebter akademischer Grad / in partial fulfilment of the requirements for the degree of
Master of Science (MSc)
Wien, 2016 / Vienna 2016
Studienkennzahl lt. Studienblatt / degree programme code as it appears on the student record sheet:
A 066 838
Studienrichtung lt. Studienblatt / degree programme as it appears on the student record sheet:
Masterstudium Ernährungswissenschaften -
Public Health Nutrition
Betreut von / Supervisor: Univ.-Prof. Dr. Jürgen König
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Appreciations
I would like to thank:
Everyone, who participated in the study: For granting me their time and interviews.
Mag. Dr. Verena Hasenegger and Mag. Dr. Hans Peter Stüger: For helping me with the
evaluation of the interviews.
Univ.-Prof. Dr. Jürgen König: For being my supervisor.
Alexander Auer, MSc (WU): For supporting and motivating me whenever I needed it.
And last but not least: My friends and family.
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Abstract
This thesis provides an insight into the Vietnamese diet. To do that the general
nutritional status of the population in Vietnam is described and the Vietnamese food
guide pyramid is represented. In Vietnam, there are still many severe nutrition problems
such as underweight, stunting and wasting. High-risk groups are here young children,
women of reproductive age and pregnant women. In the last decades, the nutritional
situation in Vietnam became much better, however there is still much room for
improvement. Furthermore, the immigration situation in Austria is described and the
changes in food habits among immigrants are analyzed. Many studies showed that a
migration to a Western country comes often with negative health effects. However,
there are several factors which play a role in the dietary behavior of an immigrant. In
Austria, the number of immigrants is continuously rising. Amongst them there are many
Vietnamese people. To analyze the eating habits of the Vietnamese population in
Austria a study with 42 subjects has been conducted. The results and outcomes were
compared to the recommendation of D-A-CH 2015. In addition, to have a comparison
between the Austrian and the Vietnamese diet, the results were also compared to the
latest Nutritional Survey of Austria in 2012.
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Table of contents 1 Introduction .............................................................................................................. 1
1.1 Research questions............................................................................................. 1
1.2 Methodology ...................................................................................................... 1
1.3 Motivation .......................................................................................................... 2
2 The Vietnamese diet ................................................................................................. 3
2.1 General nutritional status in Vietnam ................................................................ 3
2.1.1 Nutritional status of children under 5 ........................................................ 4
2.1.2 Nutritional status of children 5 to 19 years old ........................................ 10
2.1.3 Nutritional status of adults (over 19 years old) ........................................ 12
2.1.4 Nutritional status of mothers with children under 5 years old ................ 13
2.2 Micronutrient deficiencies and breastfeeding practices ................................. 14
2.2.1 Micronutrient deficiencies ........................................................................ 14
2.2.2 Situation of breastfeeding ........................................................................ 15
2.3 Trends in food consumption ............................................................................ 16
2.3.1 Changes in food consumption in the General Nutrition Surveys ............. 16
2.3.2 Changes in nutrient intake ........................................................................ 17
2.3.3 Changes in dietary energy intake and energy proportion ........................ 17
2.4 Conclusion and future proposal ....................................................................... 18
2.5 The Vietnamese food guide pyramid ............................................................... 20
2.5.1 Differences towards the Austrian food guide pyramid ............................ 21
3 Migration and Nutrition .......................................................................................... 25
3.1 Migration in Austria .......................................................................................... 25
3.1.1 The definition of migration ....................................................................... 25
3.1.2 People with migration background ........................................................... 25
3.1.3 Current numbers of immigrants in Austria ............................................... 26
3.2 Health condition of immigrants in Austria ....................................................... 27
3.2.1 Subjective health condition ...................................................................... 27
3.2.2 Overweight and obesity ............................................................................ 28
3.2.3 Physical activity ......................................................................................... 28
3.3 Changes in food habits among immigrants ...................................................... 29
3.3.1 Definition of acculturation ........................................................................ 29
3.3.2 Definition of dietary acculturation ............................................................ 30
3.3.3 The model of dietary acculturation .......................................................... 31
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3.3.4 Dietary acculturation among immigrants with a focus on immigrant women 35
3.3.5 Health status of immigrants with a focus an female migrants ................. 37
3.3.6 Health status of children with parental migration background (Second generation) .............................................................................................................. 40
3.3.7 Conclusions and future prospects ............................................................ 40
4 Materials and methods ........................................................................................... 43
4.1 Sample group.................................................................................................... 43
4.2 Instrument for data collection ......................................................................... 45
4.2.1 The work with GloboDiet .......................................................................... 46
4.3 Evaluation of data ............................................................................................ 47
4.4 Results and outcomes ...................................................................................... 47
4.4.1 Energy and main nutrients for energy delivering ..................................... 48
4.4.2 Essential fatty acids ................................................................................... 65
4.4.3 Lipo-soluble vitamins ................................................................................ 69
4.4.4 Water-soluble vitamins ............................................................................. 75
4.4.5 Mineral nutrients ...................................................................................... 84
4.5 Discussion ......................................................................................................... 90
4.5.1 Energy and energy delivering nutrients .................................................... 90
4.5.2 Dietary energy intake/ energy proportion ................................................ 93
4.5.3 Essential fatty acids ................................................................................... 95
4.5.4 Lipo-soluble vitamins ................................................................................ 96
4.5.5 Water-soluble vitamins ............................................................................. 98
4.5.6 Mineral nutrients .................................................................................... 100
4.6 Austrian diet vs. Vietnamese diet .................................................................. 102
4.6.1 Energy percentage of main nutrients and alcohol ................................. 102
4.6.2 Lipo-soluble vitamins .............................................................................. 103
4.6.3 Water-soluble vitamins ........................................................................... 104
4.6.4 Mineral nutrients .................................................................................... 106
5 Summary ............................................................................................................... 109
5.1 Conclusion ...................................................................................................... 115
6 References............................................................................................................. 117
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List of figures
Figure 1: Prevalence of underweight by ecological zones in Vietnam, 2010 (Le & Le
2010) ......................................................................................................................... 4
Figure 2: Map of the prevalence of underweight in children under 5 years by province,
Vietnam 2010 (Le & Le 2010) .................................................................................... 5
Figure 3: Map of the prevalence of stunting in children under 5 years by province,
Vietnam 2010 (Le & Le 2010) .................................................................................... 7
Figure 4: Map of the prevalence of wasting in children under 5 years by province,
Vietnam 2010 (Le & Le 2010) .................................................................................... 8
Figure 5: Prevalence of overweight in children from 5-19 years old by age and sex,
Vietnam 2009-2010 (Le & Le 2010) ........................................................................ 11
Figure 6: Prevalence of overweight in children from 5-19 years old by ecological zone,
Vietnam 2009-2010 (Le & Le 2010) ........................................................................ 11
Figure 7: Prevalence of CED in adults over 19 years old in 2000 and 2010 (Le & Le 2010)
................................................................................................................................. 12
Figure 8: Prevalence of overweight and obesity among mothers with children under 5
years of age between 2000 and 2010 (Le & Le 2010) ............................................. 14
Figure 9: Prevalence of vitamin A deficiency and anemia in children under 5 years old
by age group in 2008 (Le & Le 2010) ...................................................................... 15
Figure 10: Changes in protein and fat intake in the diet (Le & Le 2010) ........................ 17
Figure 11: The Vietnamese food guide pyramid (National Institute of Nutrition n.d.) .. 20
Figure 12: The Austrian food guide pyramid (Bundesministerium für Gesundheit n.d.)
................................................................................................................................. 22
Figure 13: Population statistics 1.1.2015 (Baldaszti et al. 2015) .................................... 26
Figure 14: Migration statistics (Baldaszti et al. 2015) ..................................................... 27
Figure 15: Proposed model of dietary acculturation: The process by which racial/ethnic
immigrant or rural-urban migrant groups adopt the dietary patterns of their new
environment (Satia 2003) ....................................................................................... 31
Figure 16: The structure of food habits (Koctuerk 1995) ............................................... 33
Figure 17: Change in food habits (Koctuerk 1995) ......................................................... 34
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Figure 18: Sex ratio of the sample group ........................................................................ 43
Figure 19: Age groups in the sample group .................................................................... 43
Figure 20: Age ratio of the sample group ....................................................................... 44
Figure 21: Vietnamese background of the parents in the sample group ....................... 44
Figure 22: Weight categories of the sample group ........................................................ 45
Figure 23: Dietary energy intake according to D-A-CH 2015 .......................................... 94
Figure 24: Energy proportion in the sample group......................................................... 94
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List of tables
Table 1: The daily intake of energy and energy delivering nutrients among Vietnamese
................................................................................................................................. 91
Table 2: The daily intake of essential fatty acids among Vietnamese ............................ 95
Table 3: The daily intake of lipo-soluble vitamins among Vietnamese .......................... 96
Table 4: The daily intake of water-soluble vitamins among Vietnamese ....................... 98
Table 5: The daily intake of mineral nutrients among Vietnamese .............................. 100
Table 6: Intake of main nutrients and alcohol in energy percentages among Austrian
and Vietnamese .................................................................................................... 102
Table 7: Intake of lipo-soluble vitamins among Austrian and Vietnamese women ..... 103
Table 8: Intake of lipo-soluble vitamins among Austrian and Vietnamese men .......... 104
Table 9: Intake of water-soluble vitamins among Austrian and Vietnamese women . 104
Table 10: Intake of water-soluble vitamins among Austrian and Vietnamese men .... 105
Table 11: Intake of mineral nutrients among Austrian and Vietnamese women ........ 106
Table 12: Intake of mineral nutrients among Austrian and Vietnamese men ............. 106
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1
1 Introduction
This chapter is meant to provide an overview of the methods used in this thesis.
1.1 Research questions
The following thesis intends to answer these core questions:
1. How is the nutritional status of the population in Vietnam?
2. What are the changes in food habits among immigrants?
3. What are the daily intakes of energy and other nutrients of Vietnamese living in
Austria?
4. How is the Vietnamese diet in comparison with the Austrian diet?
1.2 Methodology
To answer those proposed research questions, a literature review was conducted and a
study has been performed.
For the first two questions a literature review was needed. Webpages of relevant
organizations and scientific databases have been searched thoroughly.
The databases were: Pubmed, Scopus and Sciencedirect.
Search terms were: nutritional survey Vietnam, migration and nutrition, immigrants in
Austria, immigrants’ food habits, immigrants’ eating habits, immigrants’ dietary
changes, etc.
The result of the research for the first chapter ‘The Vietnamese diet’ was satisfying. The
nutritional survey of Vietnam was easily accessible as well as the Vietnamese food guide
pyramid. Altogether enough data for the first chapter was available and the author was
quite satisfied.
For the second chapter of the thesis ‘Migration and Nutrition’ the research proved to be
more complicated. It was more difficult to find current studies of food habits among
immigrants in Austria. The only relevant studies found were from migrants living in
Germany. Therefore unfortunately few data were found and also used.
For the last two questions a study was conducted. The nutrition program GloboDiet was
used to capture interviews (24-hours dietary recall) of the subjects, which is the same
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that is been used for the Austrian nutrition report. In summation, 84 interviews have
been conducted by the author (two of each subject). A detailed description of the
program GloboDiet can be found in chapter 4.2.
The evaluation of the interviews from GloboDiet result in an Excel chart. For further
evaluation the data has been aggregated into smaller pivot tables. Final analysis has
been made with the statistical program SPSS.
The results and outcomes were compared to the recommendation of D-A-CH 2015 and
as well to the latest Nutritional Survey of Austria in 2012.
Further details of the study are described in the last part of the thesis.
1.3 Motivation
The topic of this master thesis was chosen, because the author is a Vietnamese
immigrant herself. The family of the author moved to Austria because of the
consequences of the Vietnam War. So did many other families.
Today, it can be noticed that the number of Vietnamese in Austria is steadily growing.
Vietnamese restaurants and supermarkets have been on the rise especially in Vienna
and become more and more a trend in Austria. The Vietnamese people themselves have
integrated quickly and settled in for good. So, Austrians are willingly eating the food the
Vietnamese are preparing and accepting the Vietnamese culture. However, a more
interesting question is: How is it the other way around? What are the eating habits of
these immigrants? And how much is the migration process affecting an immigrant
group, in particular Vietnamese, in their food habits and dietary practices? Furthermore,
what are the influencing factors and also the limitations for people moving to a new
environment?
Due to the lack of studies analyzing the diet of Vietnamese immigrants in the world and
particular in Austria, it seems important to do research and to conduct a study to see
how the eating habits of Vietnamese people in Austria are and as well to compare the
Vietnamese with the Austrian diet.
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2 The Vietnamese diet
In this chapter the general nutritional status of the population in Vietnam is described
as well as the Vietnamese food guide pyramid in comparison with the Austrian pyramid.
2.1 General nutritional status in Vietnam
In Vietnam, undernutrition is still one of the main concerns. Children under 5 years old
are the most alarming group for undernutrition. The mortality rate for these high-risk
group is 16 per 1000 live births, where various forms of undernutrition make up nearly
45% of the deaths. On the other hand, in the last years overweight and obesity have also
become a national problem. This is known as the double burden of malnutrition
(Chaparro et al. 2014).
Since 2000, Vietnam has shown good progress in reducing stunting. However, stunting
is still one of the main problems in Vietnam. One in five children are stunted in Vietnam.
Wealth, region and ethnicity play a major role on the outcome. Breastfeeding otherwise
has a positive effect, which is why the infant and young child feeding (IYCF) practices
should be improved to reduce the high number of stunted children (Chaparro et al.
2014).
Changes in mandatory salt iodization laws in 2005 made iodine deficiency a big concern
in Vietnam again. The salt iodization is currently on a voluntary basis, which causes the
increase in iodine deficiency in the general population of Vietnam (Chaparro et al. 2014).
Almost a third of children under 5 years and women of reproductive age have anemia.
It can be caused by micronutrient deficiencies such as iron and others. In recent years
only little progress has been achieved in reducing these numbers, which makes anemia
a significant public health concern. The focus should also be on the improvement of
infant and young child feeding (IYCF) practices (Chaparro et al. 2014).
This chapter shows a summary of the latest General Nutrition Survey of Vietnam, which
has been conducted in 2009-2010. The objective of this General Nutrition Survey was to
assess the current nutritional situation and to analysis correlative factors as well as to
identify the risk factors of the Vietnamese population (Le & Le 2010).
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2.1.1 Nutritional status of children under 5
The General Nutritional Survey showed, that in Vietnam the prevalence of underweight
was 17.5% in children under 5 years. The prevalence of stunting was 29.3% and of
wasting was 7.1% in children under 5. While the prevalence of undernutrition is
decreasing, overweight and obesity has become more and more a national concern in
Vietnam (Le & Le 2010).
2.1.1.1 Underweight
There were no significant differences between underweight in girls and boys. However,
regional variations were found evident in the prevalence of underweight. The Northern
Midlands and Mountain areas, the North Central area and the Central Coastal area, and
the Central Highlands have the highest prevalence of underweight. The lowest level of
underweight in children under 5 was found in the Red Delta and the South East area (Le
& Le 2010).
Figure 1: Prevalence of underweight by ecological zones in Vietnam, 2010 (Le & Le 2010)
The Survey has also showed, that the household wealth and the prevalence of
underweight is negatively correlated. Comparing the poorest and the richest
households, the level of underweight was about 3.4 times higher in the poorest
households. That means nearly one quarter of the poor children were underweight.
In large cities compared to small cities and the rural communes the prevalence of
underweight showed to be significant lower. Also between different ethnic groups in
Vietnam the level of underweight varied largely (Le & Le 2010).
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An important factor which points out if a child is more likely to be underweight or not is
the condition of the mother pregnant with the unborn. The Survey revealed that shorter
women (maternal height less then 145cm) are more likely to have underweight babies
than taller ones. There was no difference among both girls and boys. The maternal Body
Mass Index (BMI) plays also a key role in the prevalence of underweight in children
under 5 years old. Those who are born to women with a low BMI (<18,5kg/m²) are
associated with a higher prevalence than those from women with higher BMI. It is also
evident that maternal education is related to the prevalence of underweight in children.
So, the higher the education of the mother the lower the prevalence of underweight in
their child. A similarly pattern was found for household dietary diversity. The prevalence
of underweight was almost twice as high for children with low household dietary
diversity compared to those with high household dietary diversity (Le & Le 2010).
Figure 2: Map of the prevalence of underweight in children under 5 years by province, Vietnam 2010 (Le & Le 2010)
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2.1.1.2 Stunting
In Vietnam the prevalence of stunting in children under 5 years old was 29.3%. The
prevalence of severe stunting amounted to 10.5%.
Here, the prevalence of stunting in children under 5 also had a great variation between
the different ecological zones of Vietnam. Again, the Northern Midland and the
Mountain areas, the North Central and the Central Coastal areas, and the Central
Highland areas had the highest prevalence of stunting. The lowest level was found in the
Red River Delta and the South East areas (Le & Le 2010).
Similarly to underweight, the prevalence of stunting decreased when the household
wealth was increasing. Comparing the poorest with the richest household, there was an
approximately 3 times higher prevalence of stunting among poor kids. That means, more
than one third of the poorest children were stunted. Also here, in “large cities” the level
of stunting was significant lower as it was in “small cities” or rural “communes”. The
prevalence of stunting also varied between ethnic groups in Vietnam (Le & Le 2010).
Additional factors for stunting in children under 5 is again maternal height, maternal
Body Mass Index and maternal education with a similar pattern for underweight. The
level of stunting was also 1.5 times higher in children with a low household dietary
diversity compared to those with high household dietary diversity (Le & Le 2010).
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Figure 3: Map of the prevalence of stunting in children under 5 years by province, Vietnam 2010 (Le & Le 2010)
2.1.1.3 Wasting
The prevalence of wasting in children under 5 years old was found to be 7.1% in Vietnam.
The Survey revealed a prevalence of severe wasting at 3.8%.
They found here also a variation in the different regional zones in Vietnam and the level
of wasting. Again, the Northern Midland and Mountain areas, the Central Highland, and
the North Central and the Central Coastal areas showed high prevalence of wasting. The
lowest level of wasting was in the South East and the Red River Delta areas (Le & Le
2010).
Also the household wealth showed again an association with the prevalence of wasting.
There was an approximately two times higher level in the poorest households in
comparison with the richest ones. However, the prevalence were quite similar for
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children in poor and middle level households. In the urban households the level of
wasting was as well significantly lower than in rural households.
Among ethnic groups in Vietnam it was found evident that there was a great variation
in the prevalence of wasting in children (Le & Le 2010).
Similar to the levels of underweight and stunting, the factor maternal BMI had a related
effect on the prevalence of wasting. Another associated factor is the maternal
education. A higher maternal BMI and/or a higher maternal education was associated
with a lower level of wasting in children under 5 (Le & Le 2010).
Figure 4: Map of the prevalence of wasting in children under 5 years by province, Vietnam 2010 (Le & Le 2010)
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2.1.1.4 Trends of undernutrition in children under 5:
From 2000 to 2010, the prevalence of underweight has significantly decreased. Over the
10-year-period, the average reduction rate amounted to 1.26% per year.
For children in Vietnam the prevalence of stunting has also shown a steady reduction in
the last 10 years, which is similar to underweight. Here, the average reduction rate was
1.4% per year (Le & Le 2010).
There was no significant evidence of improvement for the prevalence of wasting in the
time period from 2000 to 2010 in children under 5 years. In Vietnam, the prevalence of
wasting is considered to be at medium level by the World Health Organization (Le & Le
2010).
The prevalence of overweight (BMI from 25 kg/m² to 29.9 kg/m²) and obesity (BMI over
30 kg/m²) in children under 5 in Vietnam amounted to 5.6%. The level of obesity alone
was at 2.8%. In urban areas the prevalence of overweight/obesity was even higher at
6.5% (Le & Le 2010).
2.1.1.5 Conclusion and future prospects:
The data from the General Nutrition Survey 2009-2010 revealed that the nutritional
status of children under 5 years old in Vietnam is at a critical point. Even though great
progress has been made in this area for the past 10 years, undernutrition is still a major
national problem (Le & Le 2010).
Interventions should be targeting to high-risk groups like children under 5 years and
women during pregnancy to prevent the consequences of undernutrition as well as
malnutrition. In addition, there should be prevention programs with simple
communication strategies to reach women with lower educational status. Programs are
also needed to counsel parents on how important it is to have a wide dietary diversity
of complementary feeding for children from 6 month at age and older. And last but not
least, the improvement of the infant and young child feeding practices in Vietnam
should be on high focus to reduce the numbers of children with diseases like
underweight, stunting and/or wasting (Le & Le 2010).
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2.1.2 Nutritional status of children 5 to 19 years old
In Vietnam the prevalence of underweight in children 5-19 years old was 24.2%. The
prevalence for severe underweight was 7.2%. There was no significant difference
between girls and boys. In comparison with the numbers of children under 5 years old
(17.5%, 2.1%) the level for underweight in children 5-19 years old was even higher (Le
& Le 2010).
The prevalence of stunting in children 5-19 years old amounted to 23.4%. The level for
severe stunting was 7.1%. The result showed that there was a significant difference
between girls and boys. The prevalence of stunting and severe stunting for girls was
19.5% and 5.8%. The numbers for boys were 27.5% and 8.6%. So, the prevalence of
stunting among boys was higher than among girls of this age. However, compared with
children under 5 years (29.3%, 10.5%), the level of stunting was lower in children 5-19
years old (Le & Le 2010).
The result for wasting was 16.8% in children 5-19 years old, and the level of severe
wasting was found at 5.2%. There was no significant difference in the findings between
girls and boys. Comparing with the children under 5 years old (7.1%, 3.8%) the
prevalence of wasting and severe wasting in children 5-19 years old was again much
higher (Le & Le 2010).
The prevalence of overweight in children 5-19 years was found at 8.5%. The level of
obesity amounted to 2.5%. The result showed a significant difference in the prevalence
of overweight and obesity between girls and boys. The numbers were higher for boys
(10.2%, 6.8%) than girls (3.2%, 1.8%), but it was only statistically significant for the age
group from 5-7 years old (Le & Le 2010).
The findings also showed for children from 5 to 19 years old that as age increased the
prevalence of overweight and obesity decreased. But the data also indicated that in the
future there will be more overweight and obese children and adolescents in Vietnam (Le
& Le 2010).
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Figure 5: Prevalence of overweight in children from 5-19 years old by age and sex, Vietnam 2009-2010 (Le & Le 2010)
There was no significant variation of the overweight/obesity prevalence in different
ecological regions except for the South East, where the level of overweight and obesity
was more than double as high as in any other area (Le & Le 2010).
Figure 6: Prevalence of overweight in children from 5-19 years old by ecological zone, Vietnam 2009-2010 (Le & Le 2010)
The result showed a correlation between the maternal Body Mass Index and the
prevalence of overweight and obesity in children from 5 to 19 years old. So, children of
overweight mothers with BMI >25kg/m² were more likely to get overweight and obese
than those children of mothers with BMI <25kg/m² (Le & Le 2010).
The maternal education level was also related to the prevalence of overweight/obesity
in children 5-19 years old. The weird fact was, that the prevalence increased when the
maternal education increased. So, the overweight/obesity prevalence for children with
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mothers with no education was 6.2% and the level for women with secondary education
or higher was found at 15.4% (Le & Le 2010).
2.1.2.1 Conclusion
The findings of the General Nutrition Survey 2009-2010 showed that the nutritional
status of children from 5 to 19 years old in Vietnam is still at a critical point. It revealed
that undernutrition is also in this age group a major national health problem. And the
future trends for these age groups will also be a higher prevalence of overweight and
obese children and adolescents especially in large cities of Vietnam (Le & Le 2010).
2.1.3 Nutritional status of adults (over 19 years old)
In Vietnam the chronic energy deficiency (CED) is one of the main concerns for adults.
CED is defined by BMI under 18,5kg/m².
The prevalence of CED in adults in Vietnam was found at 17.2%. There was a significant
difference in the prevalence of CED between the females and males in Vietnam. The CED
level in women was at 18.5% and the level for men was found at 15.8% (Le & Le 2010).
Observing the prevalence of CED in 2010 and comparing it with the number of 2000, it
was noted that the CED level decreased in almost all age groups. The levels of CED in
adults less than 25 years old and over 55 years old were higher than in any other age
group (Le & Le 2010).
Figure 7: Prevalence of CED in adults over 19 years old in 2000 and 2010 (Le & Le 2010)
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The prevalence of overweight and obesity in adults in Vietnam amounted to 5.6%. In the
age group of adults from 55 to 59 years old the highest overweight and obesity level was
found. For males in this age group the prevalence was 7.8% and for females 10.9%. The
prevalence of overweight/obesity was not significantly different between women and
men in Vietnam (Le & Le 2010).
In the South East (including Ho Chi Minh City) the highest level of overweight and obesity
was found. There the prevalence was 10.7%. The result showed that overweight and
obesity was significantly more prevalent in urban areas than in rural areas (Le & Le
2010).
2.1.4 Nutritional status of mothers with children under 5 years old
In Vietnam, there was great progress of reducing malnutrition in children in the past
years. But the focus should also be on pregnant women because the nutritional status
of mothers has a big impact on the development and future life of their children. So, as
an aim of reducing the prevalence of undernutrition in children, the time period of
women during pregnancy through the first two years of the child’s life should be on
focus. Because deficiencies during this critical period are leading to lifelong damages of
the child (Le & Le 2010).
According to the World Health Organization, maternal undernutrition is very common
in many developed countries. More than 10% of global diseases are accounted to
malnutrition in mothers and children (Le & Le 2010).
In 2010, the prevalence of chronic energy deficiency in mothers with children under 5
years old was found at 20.2%. It was observed that the highest CED level was in young
mothers aged 15-19 years old. From 2000 to 2010, the prevalence of CED in mothers
had decreased slowly with an average reduction rate of 0.65% per year (Le & Le 2010).
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Figure 8: Prevalence of overweight and obesity among mothers with children under 5 years of age between 2000 and 2010 (Le & Le 2010)
Figure 8 indicates that the trend of overweight and obesity in mothers with children
under 5 years old was clearly increasing over the years. Compared to 2000, the
prevalence of overweight/obesity among mothers had more than doubled in 2010 (Le
& Le 2010).
2.1.4.1 Conclusion and future prospects
At the moment, one of five mothers in Vietnam is underweight (CED). So, interventions
to increase the nutritional status of mothers should be a high priority to reduce the
prevalence of newborns with malnutrition. To make this happen will be a difficult hurdle
that Vietnam has to take in the next decade (Le & Le 2010).
2.2 Micronutrient deficiencies and breastfeeding practices
2.2.1 Micronutrient deficiencies
Micronutrient deficiencies like vitamin A, iron and zinc are at high level of public health
significance in many countries, including Vietnam. High-risk groups for these deficiencies
are particularly children and women of childbearing age (Le & Le 2010).
In Vietnam, the prevalence of anemia was 29.2% and the level of pre-clinical vitamin A
deficiency was found at 14.2%. Both were at an average level of public health
importance. In recent decades, the prevalence of anemia and vitamin A deficiency had
slightly decreased but still remain a major national concern (Le & Le 2010).
15
The highest prevalence of vitamin A deficiency was found among children in the
Highland region at 20.9%. The prevalence of anemia among children in the Northwest
area was 43%, which was the highest compared to any other ecological area in Vietnam
(Le & Le 2010).
Figure 9: Prevalence of vitamin A deficiency and anemia in children under 5 years old by age group in 2008 (Le & Le 2010)
As seen in Figure 9, the prevalence of anemia decreases significantly with age. The
highest percentage of anemia was found in children between 0 to 23 month old at 44-
45%. Similarly, the level of vitamin A deficiency was highest in children in the age group
less than 12 months old with 29% (Le & Le 2010).
These result revealed that micronutrient deficiencies at this age make these young
infants most likely prone to further undernutrition in their future life (Le & Le 2010).
2.2.2 Situation of breastfeeding
It is well known that breast milk has all nutritious ingredients that a newborn needs.
Furthermore, it can prevent undernutrition and micronutrient deficiencies in children,
and also protect the infant against oxidation. Exclusive breastfeeding in the first six
months is as well recommended to prevent children’s overweight and obesity. Many
studies have shown that breastfeeding is not only beneficial for the child but also for the
mother’s health (Le & Le 2010).
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In Vietnam, the prevalence of exclusive breastfeeding until 6 months of age was 19.6%,
which is a very low percentage, knowing all the benefits coming along with
breastfeeding. 25.8% did exclusive breastfeeding until 4 months of age, whilst up to
34.6% of children under 24 months old were receiving bottle feeding (Le & Le 2010).
There should be more interventions in Vietnam pointing out the many advantages of
breastfeeding over bottle feeding. These programs should ensure that communication
is delivered effectively to reach also woman with low education levels (Le & Le 2010).
2.3 Trends in food consumption
In Vietnam in the year 1985, the mean daily food consumption was at 782.2g per capita.
In 2009 to 2010, the mean consumption was at 877.2g per capita. So, the General
Nutrition Surveys showed that the total daily food intake was slightly increasing over the
years, but the difference was not statistically significant. The primary change in food
consumption was the increased amount of food from animal sources. So in 1985, the
percentage of food intake from animal sources was found at 12%. In 2010, the
percentage amounted to 21%. These changes were leading further to a change in the
dietary compositions of the Vietnamese (Le & Le 2010).
2.3.1 Changes in food consumption in the General Nutrition Surveys
In addition to the increased energy consumption in total, the dietary composition of the
food intake per capita has also changed in Vietnam. Over the decades, the meat and
poultry consumption was increasing nearly eight times. So, the mean intake of meat and
poultry was only 11.1g per capita and day in 1985, and by 2010 the mean intake of meat
and poultry increased to 84g per capita and day (Le & Le 2010).
The daily consumption of fruits per capita was only 2.2g in 1985. In 2010, the daily intake
amounted to 60.9g per capita. So, also the total intake of fruits was increasing greatly in
Vietnam. The daily fish intake per capita increased as well among the Vietnamese
people. So in 1985, the daily fish consumption was 35g per capita and in 2010 it was
found at 59.8g per capita. The consumption of egg and milk increased from 0.8g per
capita and per day in 1985 to 29.5g per capita per day by 2010. There is an observing
trend in the increased intake of milk and milk products in the last years, but the milk
17
consumption in general still remains low in Vietnam. There is only limited production
and storage of milk and milk products in Vietnam, and the imported products are quite
expensive, so that only a few numbers of families can afford to buy them. In comparison,
the amount of vegetables that were consumed daily among Vietnamese was 214g per
capita in 1985, by 2010 the daily intake of vegetables was only 190g per capita. Even
though, the total daily consumption of vegetables had decreased, the vegetable
consumption was more diversified in the last past years in Vietnam (Le & Le 2010).
2.3.2 Changes in nutrient intake
Figure 10: Changes in protein and fat intake in the diet (Le & Le 2010)
In Vietnam, the daily protein intake per capita was slowly increasing over the years. In
1985, the amount of protein consumption was 52g/capita/day. In 2010, the protein
intake was found at 74.3g/capita/day. The increased consumption of animal protein in
the diet of Vietnamese people had been observed. There were also significant
differences in the consumption of protein between urban and rural regions.
Also the daily intake of oil and fat per capita increased gradually from 12g in 1985 to
37.7g in 2010 (Le & Le 2010).
2.3.3 Changes in dietary energy intake and energy proportion
In Vietnam, there had been a remarkable change in the dietary energy intake over the
past decades. The proportion of total energy intake had changed from 1985 with 11.2%
18
from protein, 6.2% from fat and 82.6% from carbohydrates to 15.9% from protein, 17.8%
from fat and 66.3% from carbohydrates by 2009. The current energy proportion is noted
to be more optimal compared to the previous ratio. These changes in dietary patterns
among Vietnamese showed that the food consumption in Vietnam has improved greatly
(Le & Le 2010).
2.4 Conclusion and future proposal
The effects of undernutrition in children remain a major problem of public health in
Vietnam. Currently, the estimated numbers of undernourished children are: 1.3 million
underweight, 2.1 million stunted and about 520,000 wasted. These numbers have great
variation between different geographical regions (Le & Le 2010).
The prevalence of overweight and obesity are also on the rise amongst Vietnamese
people. The overweight/obesity rate in children, especially in large cities, is even higher
than the control level defined by National Nutrition Strategy in 2001-2010 which is at
5%. In 2010, the prevalence of overweight and obesity was 8 times higher than in 2000.
The emerging trend here for the future are increasing levels of overweight and obese
people (Le & Le 2010).
Initiatives for reducing stunting in children should be focusing throughout the critical
time period during pregnancy and the first two years of a child’s life. These programs
should be aimed at poor households and mothers with poor nutritional and educational
status. Also geographical areas with high stunting rates should get high attention (Le &
Le 2010).
Another issue of big national importance are the micronutrient deficiencies. Iron
deficiency anemia is one of the leading causes of maternal mortality and stunting in
children in Vietnam. The prevalence of anemia is highest among children under 5 years
old, women of reproductive age and pregnant women. Pregnant women with anemia
are at very high risk of mortality among their newborns and as well themselves (MDG
Achievement Fund 2013).
Strategies to reduce micronutrient deficiencies should be implemented by enhancing
the food diversity on intakes. Hence, the intakes of micronutrient in children and the
19
general population will increase and prevent them from micronutrient deficiencies
(MDG Achievement Fund 2013).
Maternal nutrition during pregnancy plays a significant role in the development of a
child’s future life. Nutrition counseling services should be provided to parents, in
particular mothers, on the importance of maternal nutrition during pregnancy and after
birth to reach the recommended levels of nutrient intake. Also breastfeeding practices
and adequate complementary feeding should receive specific focus in these programs
to improve the nutrient intake of infants. The target groups for these interventions are
children under 5 years old, women of reproductive age and pregnant woman (Le & Le
2010).
In the past 30 years, there has been a remarkable change in the proportion of total
energy intake. The current ratio of protein, fat and carbohydrate intake is considered to
be relatively ideal. Food consumption in the general population of Vietnam has
improved greatly over the decades. Nonetheless, an update of nutritional guidelines is
required to adapt recent social and economic changes in order to avoid
overcompensation leading to overweight and other conditions which will have a
negative impact on health (Le & Le 2010).
Monitoring and evaluation on all levels should be strengthened for the purpose of
supporting nutrition intervention in Vietnam to control malnutrition in children,
adolescents and adults (Le & Le 2010).
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2.5 The Vietnamese food guide pyramid
Figure 11: The Vietnamese food guide pyramid (National Institute of Nutrition n.d.)
This three-dimensional food guide pyramid is directed to the general population of
Vietnam. The food pyramid contains messages with the recommended amount of
monthly consumption for each food group for an adult. It is divided into seven layers
according to recommended levels of consumption. Cereals and tubers are at the bottom
of the pyramid, followed by vegetables, fruits, protein-rich foods, fats and oils. Sugar
and salt are at the top of the pyramid. The Vietnamese have also guidelines/tips for
healthy nutrition in addition to their food guide pyramid (National Institute of Nutrition
n.d.).
21
10 tips for healthy nutrition (here in English):
Eat a range of meals that include all four food groups: carbohydrates, protein, fats,
and vitamins and minerals.
Eat protein-rich foods from a good balance of vegetable and animal sources.
Increase the intake of shrimp, crab, fish and beans/peas.
Eat appropriate amounts of vegetable and animal fats/oils with a good combination
between them. Sesame and peanut oils are recommended.
Do not use too much salt. Iodized salt is recommended.
Eat vegetables and fruits every day.
Ensure food safety rules during selection, processing and preservation of foods.
Drink an adequate amount of boiled water every day.
Initiate breastfeeding right after birth, exclusively breastfeed during the first 6
months, then start proper complementary feeding and continue breastfeeding until
24 months.
Children over 6 months of age and adults are recommended to consume milk and
dairy products appropriate to their age.
Increase physical activity, maintain an appropriate weight, abstain from smoking and
limit your consumption of alcoholic/soft drinks and sweets (National Institute of
Nutrition n.d.).
2.5.1 Differences towards the Austrian food guide pyramid
The Austrian food guide pyramid has also seven layers. In addition, it is also separated
into portions which represent the daily recommended portions of consumption of each
food group. The Austrian food pyramid is also applicable for kids.
At the bottom of the Austrian pyramid are non-alcoholic beverages such as water and
tea. The Vietnamese do not include beverages in their pyramid, only the guidelines say
you should drink enough water every day, but not how much. The layer at the bottom
of the Vietnamese pyramid are cereals and tubers. The Austrian have cereals at the third
layer from the bottom. Another difference is that the Austrian combined fruits and
vegetables in one layer between beverage and cereals. In the Vietnamese pyramid the
22
vegetables are followed after the cereals, and after the vegetables come the fruits. The
next layer of the Vietnamese pyramid is fish, seafood, tofu and meat. The amount of
consumption also should be in this order with the first one the most. The Vietnamese
have seafood and tofu in their protein-rich food layer which the Austrian one does not
have. Instead the Austrian pyramid includes also eggs in their meat and fish layer. The
Austrian food guide pyramid have an additional layer with milk and milk products which
also contain the olive oil. The milk layer comes before the meat layer. The Vietnamese
food pyramid does not have recommendations for milk consummation. This is maybe
one reason why the milk consumption in general is really low in Vietnam. The next layer
of the Vietnamese pyramid which follows the fish and meat layer are the fats and oils.
In the same order is the Austrian one. On top of the Austrian food pyramid are fatty and
salty foods, sweets as well as soft drinks. The Vietnamese pyramid has sugar and salt
separately.
Figure 12: The Austrian food guide pyramid (Bundesministerium für Gesundheit n.d.)
23
The separation into portions of each layer of the Austrian food guide pyramid makes it
easier for people to understand and follow the recommendation of consumption. The
Vietnamese food pyramid has messages besides the recommended amount of monthly
consumption for each food group. These recommended amounts for one month make
it hard for people to follow the recommendation as it is hard to remember the exact
amount of food and/or an ingredient consumed during a day or even for a whole month.
The recommendation should be on a daily basis to make it easier to adapt. Also there
should not be exact amounts given as recommendations.
The Vietnamese food guide pyramid is only intended for adults. It is not applicable for
children. In Austria, a food guide pyramid specific for pregnant and lactating women has
been developed. It is the same food pyramid only with extra portions adapting to the
needs of pregnant and lactating women.
Vietnam should improve their food guide pyramid and their guidelines for better
understanding and easier following of the recommendation. This is very important to
prevent malnutrition in the Vietnamese population which is still a major national
problem.
24
25
3 Migration and Nutrition
This chapter gives an overview of the migration in Austria and describes the process of
dietary acculturation among immigrants.
3.1 Migration in Austria
Since the 1960s, the demographic development of Austria was influenced by
immigration. First, the immigration was characterized through the recruitment of
working immigrants, the so-called guest workers. In the beginning of the 1990s, also
many war refugees came from the former Yugoslavia to Austria. But by 1992-1993, the
number of immigrations was reduced because of the new quota system. With the
migration from the enlarged EU region and the family reunification the immigration
increased again from 2001 onwards (Anzenberger et al. 2015).
3.1.1 The definition of migration
There is no standardized, official definition of migration in Austria and the European
Union. The term "migration" describes the process of people migrating across borders,
to live and work there, permanently or temporarily. Migration is a highly dynamic
process (Bundeskanzleramt Österreich n.d.).
3.1.2 People with migration background
The population with a migration background refers to all persons whose parents were
born abroad, regardless of their nationality. In 2014, there were about 1.715 million
people with an immigrant background living in Austria that was about 20.4% of the total
Austrian population. The persons with a migration background are divided into two
groups. There were about 1.254 million immigrants of the first generation who were
born abroad themselves and moved to Austria. About 460,000 subjects were from the
second generation who are born in Austria and whose parents were born abroad.
Around 59% of the population with an immigrant background are foreign nationals,
while 41% own an Austrian citizenship. Among the immigrants of the first generation
only one-third (32%) was nationalized, while two-thirds (66%) of the members of the
second generation are Austrian national citizens (Bundeskanzleramt Österreich n.d.;
Baldaszti et al. 2015).
26
3.1.3 Current numbers of immigrants in Austria
In the beginning of 2015, there were around 1.146 million foreign residents in Austria.
The foreigners made up to 13.3% of the total population. The increase of more than
80,000 foreign national citizens compared to the beginning of 2014 is the result of a
positive migration balance of the foreign population (Baldaszti et al. 2015).
Among foreign nationals in Austria, the Germans are still by far the largest group. On
January the 1rst of 2015, more than 170,000 Germans were living in Austria, followed
by 115,000 Turkish and 114,000 Serbian citizens. On the fourth and fifth place Bosnia
and Herzegovina (93,000) and Romania (73,000) were ranked. On the ranks six to ten,
there were the nationals of Croatia, Hungary, Poland, Slovakia and Russia. From outside
Europe there were about 17,000 Afghan nationals accounted for the largest nationality
followed by respectively 11,000 Chinese and Syrian citizens (Baldaszti et al. 2015).
Figure 13: Population statistics 1.1.2015 (Baldaszti et al. 2015)
27
There was also a clear increase of asylum aspirants in Austria. In 2011, the number of
asylum applications was around 14,400. In 2012 and 2013, the number rose to 17,500
and in 2014, it was 28,100. Even more significant was the number of persons who
received political asylum, from about 4,100 people in 2013 to 11,600 in the year 2014.
The most asylum aspirants came from Syria (7,730) and Afghanistan (5,076). Compared
to other EU nations, Austria was ranked seventh in 2014 by the absolute number of
asylum applications. In relation to the population, however, Austria was on the third
place (after Sweden and Hungary) (Baldaszti et al. 2015).
Figure 14: Migration statistics (Baldaszti et al. 2015)
3.2 Health condition of immigrants in Austria
3.2.1 Subjective health condition
Immigrants from the former Yugoslavia (excluding Slovenia) and Turkey estimated their
health condition as rather poor. Only 67% of men and 62% of women reported to feel
good or very good on health. A poor or very poor health was indicated by 13% of men
and 14% of women. Men and women from Austria and the EU countries rated their
health better.
In the HBSC study (Health Behaviour in School-aged Children) pupils in the ages 11, 13,
15 and 17 years were asked about their health condition. The result showed that
children and teenagers with an immigrant background estimated their health more
28
negatively than children and teenagers without an immigrant background. However, the
level of wealth of the family played here a major role (Anzenberger et al. 2015).
3.2.2 Overweight and obesity
Immigrants, standardized for age, were more likely to be obese than people without an
immigrant background. For women these differences were provided more precisely:
Immigrant women (23%) were twice as likely obese than women without a migration
background (11%) in Austria. For men these differences were rather small: 17% of the
migrants were obese and 11% of the men without an immigrant background. The risk of
obesity was for migrant women and men statistically significant higher than for those
without an immigrant background. In Austria, immigrant men had a 1.8-fold higher risk
and immigrant women a 2.5 times higher risk of being obese (Anzenberger et al. 2015).
High attention should be also be paid to kindergarten and school. Here, the correlation
of migration and overweight was quite clear. In a project by SIPCAN (Special Institute for
Preventive Cardiology And Nutrition), in which also experts from the Medical University
of Vienna participated, a study with 617 Viennese students was conducted. They found
that 70% of the overweight children have a migration background. In addition, the study
found out that 19% of the children with an immigrant background consumed fast food
several times a week. At the same time, the result showed that more children with an
immigrant background were daily eating fruit and vegetables, namely 31% compared to
14% of the local kids. This showed that prevention measures may already be effective in
this age group (SIPCAN „Initiative für ein gesundes Leben“ n.d.).
3.2.3 Physical activity
Regarding physical activity there were also differences according to migration
background and gender. Approximately one third of men with no migration background
(32%) were physically active in Austria. For men with an immigrant background the
percentage was about 28%. Women were more rarely physically active. Almost a quarter
(24%) of women without an immigrant background and only 15% with were active in a
physical way. In the age group of 15 to 34 years old men there were no differences in
physical activity according to migration background (40% physically active). Women with
29
a migration background were less active than women without an immigrant background
in all age groups in Austria (Anzenberger et al. 2015).
3.3 Changes in food habits among immigrants
The number of immigrations all over the world is steadily increasing. There are
immigrations to developed countries and there are rural-urban migrations within
developing countries. For the person that immigrates this can be a major change in his
or her lifestyle and environment, which also can result in increased risk of chronic
diseases (Satia 2003). For example, a study from Ziegler and colleagues (Ziegler et al.
1993) showed that Asian-American immigrant women who had migrated to the West
over a decade or longer ago had an 80% higher risk of breast cancer than migrants who
just moved recently. There are many migrant studies revealing that the change toward
a “Westernized” lifestyle results in a higher risk of different major chronic diseases. The
most concerned shift is the adoption to a “Western” diet which is a serious risk factor
for chronic diseases among immigrants. The process by which the immigrants adopt new
dietary patterns is known as dietary acculturation (Glade 1999; National Research
Council (US) Committee on Diet and Health 1989).
3.3.1 Definition of acculturation
Acculturation is the process by which a group, usually a minority, adopts the cultural
pattern of its host country. This can be adaptations in belief, religion and language for
instance. The process of acculturation can occur on micro and macro levels. On the
micro or individual level which is known as the “psychological acculturation”, changes in
attitudes, beliefs, behaviors and values in individuals occur. The macro or social/group
level refers to physical, biological, political, economic and cultural changes in the
acculturation group as a whole. There are many different factors which play a role if an
individual or a group makes adaptations to a new society. Clear is that the more different
the immigrant’s original and host cultures are the more difficult the acculturation will
be (Satia 2003).
30
3.3.2 Definition of dietary acculturation
Dietary acculturation is the process by which members of a migrating group adopt the
food choices and eating habits of their new environment. For instance, when a Korean
immigrant in the US eats more “Western” foods such as hamburgers, French fries and
potato chips than traditional Korean dishes like Kimchi, Galbi gui and Doenjang jigae.
One characteristic of dietary acculturation is the reciprocal way of adaptions. Which
means not only the immigrants make new changes in their diet but also the host group
may adopt some of the migrant’s food and dietary practices to their own. This can be
noted in the rising number of ethnic supermarket and restaurants all over the developed
countries (Satia 2003).
Dietary acculturation is a multidimensional, dynamic and complex process. Studies
showed that immigrants may keep some traditional foods and exclude others. They may
find new ways of preparing traditional dishes with foods available in the host country.
Some studies also indicated that at dinner time immigrants were more likely to eat
traditional meals, maybe because they consume the dinner with other family members.
Breakfast and lunch on the other hand are more likely to be “Westernized”. So,
acculturation can be adopted only partly or fully to the host environment. It is also
important to know that dietary acculturation can have both positive and negative
dietary changes which leads to positive and negative health consequences. For example,
the decreased consumption of seafood and increased intake of red meat are unhealthy
changes for an Asian immigrant, while eating a larger variety of fruit and vegetable is a
healthy change resulting from dietary acculturation (Satia et al. 2001; Otero-Sabogal et
al. 1995; Satia et al. 2000; Lee et al. 1999; PAN et al. 1999; Raj et al. 1999; Bermúdez et
al. 2000).
There are many factors influencing the dietary acculturation which can result in many
different patterns and habits of food intake (Satia 2003).
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3.3.3 The model of dietary acculturation
Figure 15: Proposed model of dietary acculturation: The process by which racial/ethnic immigrant or rural-urban migrant groups adopt the dietary patterns of their new environment (Satia 2003)
As seen in Figure 15, there are socioeconomic, demographic and cultural factors which
can influence the exposure to the host culture. As a result of this set of characteristics
the extent to which new immigrants may make changes in psychological factors and
taste preferences is predictable. Also, changes in environmental factors leading to
changes in food procurement and preparation are notable. At the end, these factors can
lead to different patterns of dietary intake (Satia 2003).
It has been identified that the factors longer residence in the host country, high
education and income of the immigrant, and employment outside the home result in a
higher exposure to the host culture. Also the factors being married, having young
children and fluency with the host language play a major role for exposure and
consequently acculturation. This, however, does not mean that when one can read and
speak the host language fluently he or she will completely adopt the food habits of the
host country. The generation level may be also a good index of dietary acculturation. As
32
research has indicated, higher generations (third or fourth) of immigrants were more
likely to adopt the eating patterns of the host country compared to the first generation
immigrants (Satia 2003).
Changes in beliefs and knowledge of diet and diseases can be a result of the exposure
to the host culture trough television, radio, books, advertisements, etc. For example, the
exposure to nutrition and health messages in the host country can lead to changes in
the beliefs of diet and chronic diseases (Satia 2003).
The exposure to a new food supply can induce an immigrant to change his or her food
procurement and preparation. The unavailability of traditional foods and ingredients
such as certain types of vegetables or spices makes it harder for immigrants to prepare
traditional meals and they will as a result consume more foods of the host county. Also,
the traditional foods are often very expensive in the host country and are therefore not
affordable for everyone. The time-consuming preparation of traditional dishes is also an
issue why immigrants may prefer more convenient prepackaged foods or to go to
abundant fast food restaurants. These environmental or “daily life” factors are one of
the most common reasons for dietary acculturation among immigrants (Satia 2003).
There are three different ways of the impact of dietary acculturation on an immigrant.
First, the immigrant maintains his or her traditional food habits. Second, the immigrant
fully adopts the host environment foods and eating patterns. Or third, there will be an
incorporation of the host foods and eating habits into their own diet while also
maintaining some traditional dietary practices. The third way of dietary acculturation is
also called biculturalism (Satia 2003).
There is another model of changes in food habits from Koctuerk which was used in many
studies for the process of dietary acculturation.
In this model, the food is separated in three main groups with different degrees of
importance according to their role in a dish and/or meal. Here, staple foods play the
central role with the complements on second and accessory foods on third place
(Koctuerk 1995).
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Figure 16: The structure of food habits (Koctuerk 1995)
The staple food(s): A staple food is a food rich in carbohydrates with mild/neutral taste
which is inexpensive and available in an environment. It is the principal component of a
meal. Staple foods are only a few food items, such as bread, rice or potatoes. The staple
food is the most important element in a dish due to its possibility to identify individuals
according to their staple foods. For example, Asians are rice-eaters and North European
typically eat boiled potatoes. So, a staple cannot be substituted easily by another item
because this would change the food tradition of a dish (Koctuerk 1995).
The complementary foods: Complements to staple foods are one or several items from
four food groups which are meat/fish/eggs, milk/cheese, vegetables and legumes. The
staple foods combined with the complements form the basic foods. While a staple food
should not be substituted, complementary foods can be exchanged with other items
without ruining the whole food culture (Koctuerk 1995).
The accessory foods: Accessories are food groups including items such as fats, herbs and
spices, sweets, nuts, fruits and drinks. Their role is to enhance the taste of a meal and
make it more presentable like the function of accessories that add a final touch.
Accessory foods are the least important for the survival of a food tradition, they are less
tied to cultural identity which is why accessories can be substituted according to taste
(Koctuerk 1995).
34
Figure 17: Change in food habits (Koctuerk 1995)
The staple food in the traditional Vietnamese diet is rice which is often combined with
this complements: quick-fried meat or fish and vegetables. These food items form the
main dish of a Vietnamese meal. Accessory foods to the main dish are specific sauces
and clear soups or tea as drinks. The most consumed fruits in Vietnam are of tropical
origin. The consumption of desserts and sweets is quite low and the sources of fat for
cooking are usually soy bean oil and pork lard. So, after Vietnamese moved to the UK
the first dietary change that could be noted is the increased intake of “Western” drinks
such as coffee, carbonated drinks and beer. Also the consumption of cakes, muffins,
potato chips and other snacks was quite high and the use of pork lard decreased in favor
of butter. However, the staple food rice has maintained a central role in the Vietnamese
diet in combination with quick-fried meat or fish and vegetables (Carlson et al. 1982).
As seen in the example with the Vietnamese immigrants in the UK, changes in food
habits start with the accessory foods. This is because of their role as “taste-givers” in
meals and also because they can be exchanged without ruining a whole food tradition.
Since this group of food includes fats, sweets and drinks, such changes can have large
impacts on health (Koctuerk 1995).
So, usually changes of food habits begin from the outer shell towards the core. In case
of the diet, the change begins with incorporation of new accessories then continues with
different complementary foods and finally ends with the exchange of new staples. The
closer the change is coming towards the center, the slower is the process of change. The
35
reason for the slower change is that the attachment of traditional staple foods is the
strongest. Italians who migrated to the USA still regularly eat their traditional staple
foods which is pasta and bread. Thus, a staple is the last food item that changes in a diet
if it changes at all. On the other hand, when a person starts to consume the staples of
another culture routinely, it can be assumed that he or she has totally changed his or
her dietary habits (Koctuerk 1995).
As mentioned before, changes in eating patterns are also possible. The meal having the
most culture-loaded value changes last, while those which are culturally neutral change
first. The first noted change in eating patterns of immigrants is the increased “snacking”
between meals. Breakfast seems to be the least culture-loaded meal among immigrant
followed by lunch where often the contact with the new society and its culinary norms
takes place. The dinner is the preferred meal for traditional foods and dishes which is
commonly consumed with other family members. This meal has the most value for
traditional culture and is therefore strengthening the sense of belonging and security
(Koctuerk 1995).
3.3.4 Dietary acculturation among immigrants with a focus on immigrant women
According to The Organization for Economic Cooperation and Development (OECD)
there are six main countries receiving 77% of overall immigrant populations which are
the United States, Canada, Australia, United Kingdom, Germany and France. The total
number of international migrants has more than doubled over the last decades. In 1975
there were 20 million international migrants and by the year 2000 there were over 44
million immigrants. With a gradually increase of this number there will be about 405
million migrants by 2050 (Popovic-Lipovac & Strasser 2013).
One of the main factor for migration are economic reasons which lead people from low
human development to high human development countries. Three key areas of
movement are noted: to Europe from Asia, to North America from Asia, and to North
America from Latin America (Popovic-Lipovac & Strasser 2013).
Food habits are often the last that will adapt to the new culture and environment.
Maybe because eating habits play an important symbolic, religious and social role in the
lives of people all over the world (Popovic-Lipovac & Strasser 2013).
36
As said before, dietary acculturation in Western countries is associated with negative
choices in the dietary pattern like high consumption of fat and sugar, low consumption
of fruits and vegetables in the diet, lower physical activity, higher Body Mass Index and
bigger portion sizes for examples. As a result of such changes in food habits the risk of
chronic diseases including obesity, hypertension, cardiovascular diseases, type 2
diabetes mellitus, metabolic syndrome, mental diseases and even cancer are
increasingly high among immigrants (Popovic-Lipovac & Strasser 2013).
At this point, it is important to know that not all people from the same ethnic group
react similarly to dietary acculturation. So for example, Asians and Hispanic consist of
very different subgroups. That means factors that are influencing dietary acculturation
in one subgroup (e.g. Chinese Americans) may not have the same effects for another
subgroup (e.g. Korean Americans) (Satia 2003).
High attention concerning this topic should be given to immigrant women who are
negatively influenced by migration and dietary acculturation due to their double burden
being female and also being a migrant (Popovic-Lipovac & Strasser 2013).
There are many studies revealing that female migrants have adopted several unhealthy
food habits to their traditional diet such as high consumption of fat and sugar snacks
and drinks, as well as fast foods. The women also reported that they were gaining weight
much faster than when they were living in their home country. The main reasons of this
negative acculturation are different barriers which are resulting from the new
environment. So, one barrier is the high price of healthy food. When unhealthy products
are much cheaper and maybe also taste better then unhealthy foods which are high in
fat and sugar are more likely purchased (Koctuerk 2004). Another reason is that
immigrants from low-income countries may have an easier access to highly processed
foods in the host country and paired with a low nutritional knowledge this may lead to
negative implications for health (Holmboe-Ottesen & Wandel 2012). Also the availability
of traditional foods and ingredients is a huge barrier to cook traditional dishes. The
children’s preferences as well play a major role in the choices a mothers is making.
Another barrier is the uncertainty towards new foods maybe caused by language
barriers. Additionally, convenient and affordable fast food restaurants and prepackaged
37
dinners make it harder for female migrants not to adopt these unhealthy food habits
(Satia 2003; Koctuerk 2004; Mellin-Olsen & Wandel 2005; Bayanzadeh 2008).
Female migrants need specific attention due to their reproductive role which creates
unique nutrition needs and due to their role in buying and preparing the family meals.
Thus, women have a strong impact on the dietary practices and health behavior of the
whole family (Popovic-Lipovac & Strasser 2013).
3.3.5 Health status of immigrants with a focus an female migrants
The term “healthy migrant effect” is mentioned in several studies. It describes the
phenomenon when immigrants upon arrival in the new host country have a better
health profile than the native population. Many studies also showed that female
immigrants were healthier when they arrived and lost their health advantage at a faster
rate than compared to male migrants. There is also a positive correlation between the
mortality rate and the duration of stay in a foreign country. That means the longer an
immigrant is remaining in a host country, the worse is his or her health condition. This
is the result from changes in the health behavior among immigrants like dietary practices
and lifestyle (Popovic-Lipovac & Strasser 2013; Himmelgreen et al. 2004; Read &
Reynolds 2012).
So, studies revealed that the prevalence of overweight and obesity increases with the
duration of residence in the United States among immigrant women. This is associated
with a higher risk of cardiovascular diseases, hypertension and type 2 diabetes mellitus.
The biggest increase of overweight and obesity can be seen in those migrants who
moved at younger age to the host country. Altogether, the studies have indicated that
the longer immigrants live in the USA or Canada, the worse their health condition
becomes. On the other hand, immigrants from Europe may even have positive impacts
on their health by living in this foreign environment (Roshania et al. 2008; Lahmann et
al. 2000).
Several studies analyzed the strong relationship between social economic status
indicators and health condition among immigrants living in Europe, USA and other
countries. There are many different reasons for this trend: high market prices for healthy
foods, insecurity about new products, lack of information about food, different attitudes
38
towards health, stress, physical inactivity, marketing of cheaper, energy dense,
micronutrient-poor foods and beverages, etc. Especially for women this trend is really
dangerous with their double discrimination for being a woman and being poor and as
well their female reproductive role. Furthermore, low social economic status indicators
of a pregnant woman can not only affect their own health condition and
overweight/obesity risk but also those of the next generations (De Irala-Estevez et al.
2000).
It has been noted that there is a so-called “Hispanic paradox”. This paradox indicates
that certain immigrant groups, for example Latinos living in the USA, show a better
health status than the native population despite their low social economic status
indicators (Lerman-Garber et al. 2004).
Immigration and the resulting lifestyle changes have a great effect on the eating
practices of all groups of migrants and especially women. The main reason for this
changes is associated to the Western lifestyle connected with purchasing and preparing
meals. In USA and Canada this trend has become a major concern (Popovic-Lipovac &
Strasser 2013).
3.3.5.1 United States and Canada
In the US and Canada the food habits of the population are often connected with high
consumption of saturated fat and cholesterol which can lead to atherosclerotic diseases
and an increased risk of breast, colon and prostate cancers. There, wrong dietary
practices and other nutritional factors have been associated with 6 of 10 leading causes
of death, which are: hypertension, cancer, coronary disease, cardiovascular disease,
chronic liver disease, and type 2 diabetes mellitus. Furthermore, the prevalence of
overweight and obesity has been on the rise among all immigrant groups especially
African American and the Hispanic people (Popovic-Lipovac & Strasser 2013).
Hispanics have changed a lot of their eating patterns as a result of dietary acculturation
in the USA and Canada. The changes are for example the decreasing intake of many
traditional dishes rich in vegetables, the substitution of corn tortillas with wheat flour
tortillas which result in a higher intake of fat, the substitution of lard with butter, oil,
salad dressing, mayonnaise and sour cream, and a higher intake of white bread,
39
sweetened beverages, ready-to-eat cereals and fast food meals (Popovic-Lipovac &
Strasser 2013).
Similarly, the food habits of the Asian immigrants in the US and Canada have changed.
There is a great difference between a traditional Asian diet including high consumption
of rice, vegetables, and noodles and the North American diet mainly consisting of animal
proteins, fats and sugar. Due to the changes of dietary acculturation, the mortality rate
of heart diseases and as well the prevalence of type 2 diabetes, hypertension and breast
cancer has been increasingly high among Asian immigrants in the USA as well as Canada
(Popovic-Lipovac & Strasser 2013).
3.3.5.2 Europe
In Europe the situation is similar but with less dangerous and severe impacts on the
migrants. A recent study from Huijts (Huijts & Kraaykamp 2012) analyzed the health of
immigrants in 31 European countries. The results from this study were less explicit. The
impact that dietary acculturation has on the health of immigrants varied from no effect
at all to significant negative effects.
On the other hand, there are many studies which indicated that migrants living in
Germany are a high risk population group. The results showed higher prevalence of high
blood cholesterol levels and overweight, as well as preventive services being used
decreasingly among European immigrants (Ronellenfitsch & Razum 2004). A relatively
high risk of cardiovascular diseases have female immigrants from the former Soviet
Union in comparison with the European residents (Haas et al. 2010). In England the risk
of being overweight and obese among Indian and Bangladeshi immigrant women is
increasing. Also the prevalence of type 2 diabetes mellitus is 2-3 times higher in migrants
from India and Bangladesh than in the general population. South Asians in particular are
strongly associated with the risk of obesity especially central obesity, type 2 diabetes
mellitus, and cardiovascular diseases. This can be explained by genetic, epigenetic, and
lifestyle factors and also gene-environment interactions which predispose people from
South Asia for these diseases (Holmboe-Ottesen & Wandel 2012). In Sweden the
prevalence of chronic diseases is also higher among immigrants compared to the locals.
There, the trend of overweight and obesity is as well on the rise especially among female
40
migrants from Chile, Finland, Hungary, Southern Europe, the former Yugoslavia, and the
Middle East (Gadd et al. 2003). Immigrant women from Iran and Turkey are at high risk
for developing diabetes and cardiovascular diseases (Wiking et al. 2004). However, there
are other studies which have revealed that migrants living in Germany have lower
overall mortality rates than the local German people (Winkler et al. 2009).
In summary one can say that it is not quite possible to generalize the immigrant
population in a country. There are many different factors influencing the migrants when
coming to the host country which have to be taken into consideration (Popovic-Lipovac
& Strasser 2013).
3.3.6 Health status of children with parental migration background (Second generation)
A study conducted in Sweden discovered the association between childhood overweight
and obesity and immigration. The probability of being overweight, having low physical
activity and having the lowest level of parental education were much higher among
children of immigrant parents especially those of both parents being immigrants
(Besharat Pour et al. 2014).
So, children of one immigrant parent were 30% more likely to become overweight than
children of Swedish parents. The same likelihood could be found for low physical
activity. The children whose both parents were immigrants had a 66% higher risk of
being overweight compared to children of Swedish parents. The odds of having low
physical activity were 70% higher among children of both immigrant parents. The result
also showed that girls with both immigrants parents were the most likely to be
overweight. They had a two-fold higher risk than offspring of Swedish parents. It could
also be observed that the lower the level of parental education was the higher was the
risk of having low physical activity amongst their offspring regardless of parental
migration status. But on the contrary, children of immigrant parents had healthier
dietary patterns in comparison with Swedish children including higher intake of fruits
and vegetables (Besharat Pour et al. 2014).
3.3.7 Conclusions and future prospects
Due to the many results from different studies with the same negative outcomes of
dietary acculturation amongst immigrants around the world, there is an urgent need for
41
action for these migrants especially immigrant women and children with parental
migration background to prevent nutrition-related chronic diseases. Therefore public
health programs are urgently needed to teach immigrant women on preparing and
cooking canned and frozen foods and other products that are unfamiliar. How to read
nutrition labels and to decrease the intake of fat and sugar-modified products should be
important key points of these programs. So, the adjustment to a changed food supply
can be enabled without losing a whole traditional culture. In addition, physical activity
should be promoted to prevent associated diseases like overweight and obesity
(Popovic-Lipovac & Strasser 2013; Besharat Pour et al. 2014).
The analysis of the food culture in different immigrant groups is a main target to achieve
appropriate prevention of nutrition-related diseases among immigrants all over the
world. It should be also taken into consideration that socio-economic factors have a
greater impact on immigrants due to the fact that migrants are often poorer which is
particular important for female migrants because they are in general poorer than men.
These interventions can only be effective when dietitians and physicians are sensitive to
women’s cultural origin, values, behaviors and feelings (Popovic-Lipovac & Strasser
2013; Besharat Pour et al. 2014).
42
43
4 Materials and methods
The study which has been conducted is described in detail in the following chapter.
4.1 Sample group
Criteria of selection: Vietnamese (fully or partly), living in Austria (long or short
residence), older than 18 years
Sample size: 42 subjects, male: 17, female: 25
Figure 18: Sex ratio of the sample group
Age distribution:
Figure 19: Age groups in the sample group
40%
60%
Sex ratio
male female
9
16
6 65
0
2
4
6
8
10
12
14
16
18
18-25y 26-35y 36-45y 46-55y >55y
Age groups
44
Figure 20: Age ratio of the sample group
Subjects with both Vietnamese parents: 39, subjects with one Vietnamese
parent: 3
Figure 21: Vietnamese background of the parents in the sample group
Weight classification for adults on the basis of BMI (according to WHO 2008):
Underweight: BMI < 18.5 kg/m²
Normal weight: BMI 18.5 - < 25 kg/m²
Overweight: BMI 25 - < 30 kg/m²
Obesity: BMI >= 30 kg/m²
14
3
14
11
0
5
10
15
20
25
30
< 40y >= 40y
Age ratio
female
male
93%
7%
Parents
both Vietnamese one Vietnamese
45
Figure 22: Weight categories of the sample group
*Results on self-reported data
4.2 Instrument for data collection
GloboDiet: 24-Hour Diet Recall Interview
A 24h-recall interview is a method of collecting data to capture the foods that have been
consumed from the subject a day before the interview. The interview can be carried out
face to face or by telephone.
The data collected by a 24h-recall are much more detailed than from a closed
questionnaire such as Food Frequency Questionnaire or Diet History Questionnaire.
GloboDiet is an interview-based instrument of collecting data which enables detailed
description and quantification of the foods, dishes and dietary supplements that have
been consumed the day before the interview. With the software, a standardization of
data within and between the countries can be made. There are frequent control
questions and a chronological order of the information collecting method supporting
the memory of the subject. For the quantification of the consumed foods a photo book
with images of foods and dishes in different portion sizes was used. The software
ensures an automatic codification of the foods and recipe ingredients as well as an
0 1
11
20
6
30 10
5
10
15
20
25
male female
Weight categories
Underweight Normal weight Overweight Obesity
46
estimated calculation of the nutrient uptake.
GloboDiet is currently one of the few nutrition instrument of collecting data which
provides comparable nutrition data on a European base.
The general structure of GloboDiet:
The GloboDiet 24h-recall is divided into five main steps:
1. General information about the interviewer, the subject, the day of the interview
and also the wake up-time
2. The quick list
3. Description and quantification of the foods and recipes
4. Control of plausibility on nutrient level
5. Intake of dietary supplements
The quick list is a list where all foods and recipes which have been consumed by the
subject on the day of the interview can be registered. In doing so, the chronological
order of the meals should be considered. For each predetermined meal the consumed
foods of the subjects are noted by general definition without further description or
quantification. An extra field allows the entry of the dietary supplements.
4.2.1 The work with GloboDiet
The program GloboDiet is very precise and a course of instruction was needed. The first
interviews with GloboDiet took really long, about an hour and a half. The user manual
for GloboDiet says that an interview with a subject should take about 45 minutes. The
longer time span can be explained by the design of the program. GloboDiet is been
programmed for Austrian people on an Austrian diet. Consequently, the software does
not provide many Vietnamese foods and dishes and the author had to create new food
terms or search for the recipes in the internet. Also Vietnamese dishes consist of many
exotic ingredients, therefore it takes much longer for one interview. But with training
the author become more experienced.
Another hurdle was the language barrier of the author. The author did not know every
German word for a Vietnamese food or dish. Therefore, research was needed again. In
some cases, similar food groups have been chosen for faster results.
47
Every subject had to be interviewed two times to exclude bias depending on a specific
interview day (illness, vacation etc.). Most of the subjects could remember easily what
they have eaten the day before the interview. But there were some who did hard on
remembering. However, with the right questioning method all interviews could be
finished correctly.
4.3 Evaluation of data
Statistical analysis has been made with SPSS Statistics. All relevant nutrients were tested
against reference values. For comparison of mean values, t- tests were performed.
Boxplots were created for graphic presentation of significant differences. GLM (General
Linear Model) was used for correlations and regression calculation.
The α were set at a 0.05 level. That means that results with a probability of error of
p<0.05 were noted as significant and were marked with a star (*).
4.4 Results and outcomes
The evaluation of the intake data of the main nutrients, vitamins and minerals has been
made on the basis of the reference values for nutrient uptake from D-A-CH 2015 (Anon
2015).
48
4.4.1 Energy and main nutrients for energy delivering
4.4.1.1 Energy
MEN
For men a daily energy requirement of 2300 kcal (PAL 1.4; Age: 25 to under 51 years)
was taken into calculation.
49
There is a significant difference between the mean energy intake of Vietnamese
men and the reference value (significance value < 0.05). The men have on
average a lower total energy intake than the recommended intake.
WOMEN
For the women a daily energy requirement of 1800 kcal (PAL 1.4; Age: 25 to under 51
years) was taken into calculation.
Vietnamese women had a similar result as the men. The total energy intake
among female Vietnamese is significantly lower than the reference value.
SEX DIFFERENCE
There is no significant difference in the intake of energy between the sexes.
50
There is no significant influence of the sex or the age on the energy intake of the
Vietnamese sample group.
4.4.1.2 Protein
MEN
*Reference value for 19 to under 51 years old were used
There is a significant difference in the protein intake of male Vietnamese in
comparison with the reference value. The mean intake of protein is among male
Vietnamese much higher than the recommended intake. Vietnamese men eat
on average more than 1.5 times the recommended amount of protein.
51
WOMEN
*Reference value for 19 to under 51 years old were used
Similar results were found for female Vietnamese. The mean intake of protein
among female Vietnamese is significant higher than the recommended intake.
However, the mean value difference is not as high as for men.
SEX DIFFERENCE
The intake of protein is among male Vietnamese significantly higher compared
to the female group.
52
As the result above show, the gender has a significant influence on the protein
intake in the sample group. But there are no significant differences between the
ages.
4.4.1.3 Fat
The fat intake is recommended to be not more than 30% of the total energy intake.
MEN
For men with a daily energy intake of 2300 kcal the fat intake should be maximum 75.9g
53
per day (1 kcal = 0.11g fat).
There is no significant difference in the fat intake among male Vietnamese
compared to the reference value.
WOMEN
For women with a daily energy intake of 1800 kcal the fat intake should be maximum
59.4g per day (1 kcal = 0.11g fat).
Similar results were found for female Vietnamese. There is no significant
difference in the mean intake of fat compared to the reference intake.
SEX DIFFERENCE
54
There is no significant difference in fat intake between the sexes in the sample
group.
There is no significant influence of the sex or the age on the intake of fat amongst
the Vietnamese.
55
4.4.1.4 Saturated fatty acids
The saturated fatty acids should not account for more than 10% of the total energy
intake.
MEN
For men with a daily energy intake of 2300 kcal, the intake of saturated fatty acids should
be maximum 25.3g per day.
There is no significant difference between the mean intake of saturated fatty
acids among male subjects and the reference value.
WOMEN
For women with a daily mean energy intake of 1800 kcal, the saturated fatty acids intake
should be maximum 19.8g per day.
Similar result as for the men. The mean intake of saturated fatty acids among the
female subjects is higher compared to the reference intake, but not significantly.
56
Whereas, the mean value difference is in the female group higher than among
the males.
SEX DIFFERENCE
There is no significant difference in the intake of saturated fatty acids between
the sexes.
4.4.1.5 Monounsaturated fatty acids
SEX DIFFERENCE
The mean intakes of monounsaturated fatty acids are not significantly different
between the male and the female subject group.
57
4.4.1.6 Polyunsaturated fatty acids
SEX DIFFERENCE
No significant difference in the intake of polyunsaturated fatty acids between
the sexes.
4.4.1.7 Cholesterol
The mean intake of cholesterol in the sample group is higher than the reference
value. However, this difference is not significant.
58
SEX DIFFERENCE
The mean cholesterol intake among the male and female group are not
significantly different.
Neither the sex nor the age have a significant influence on the intake of
cholesterol in the sample group.
4.4.1.8 Carbohydrate
The carbohydrate intake should account for more than 50% of the total energy intake.
MEN
For men with a daily energy intake of 2300 kcal the intake of carbohydrates should be
at minimum 276g per day (1 kcal = 0.24g carbohydrates).
59
There is no significant difference in the carbohydrate intake among the male
group and the recommended value. However, the mean carbohydrate intake is
lower than the recommended value. To reach the actual reference intake the
mean intake of carbohydrates in the male group should be significantly higher.
WOMEN
For women with a daily energy intake of 1800 kcal the carbohydrate intake should be at
minimum 216g per day (1 kcal = 0.24g carbohydrates).
In the female group the intake of carbohydrates is significantly lower than the
calculation value. Therefore, this group does not meet the actual reference
intake for carbohydrates.
60
SEX DIFFERENCE
The intake of carbohydrates is not significantly different between the sexes.
There is no significant influence of the sex or the age on the intake of
carbohydrates in the sample group.
4.4.1.9 Sugar
The sugar intake should not be higher than 10% of the total energy intake.
MEN
For men with a daily energy intake of 2300 kcal the intake of sugar should be at
maximum 55.2g per day.
61
The mean intake of sugar in the male group is higher than the reference value.
However, the result is not significant.
WOMEN
For women with a daily energy intake of 1800 kcal the intake of sugar should be at
maximum 43.2g per day.
The mean sugar intake in the female group is significantly higher than the
reference value.
SEX DIFFERENCE
62
There is no significant difference in the intake of sugar between the sexes.
4.4.1.10 Dietary fiber
The mean intake of fiber in the sample group is 14.4g per day. There is a
significant difference to the recommended intake of 30g/day. The Vietnamese
eat less than half of the recommended amount of dietary fiber.
SEX DIFFERENCE
There is no significant difference in the intake of dietary fiber between the sexes.
63
Neither the sex nor the age have significant influence on the intake of dietary
fiber in the Vietnamese sample group.
4.4.1.11 Alcohol
MEN
For men the maximum tolerable amount of alcohol is 20g per day.
The mean intake of alcohol in the male sample group is significantly lower than
the maximum tolerable amount.
WOMEN
For women the maximum tolerable alcohol amount is 10g/day.
64
For the women group the result is not significantly different compared to the
maximum tolerable amount of alcohol.
SEX DIFFERENCE
No significant difference in the intake of alcohol between the gender groups.
There is no significant influence of the sex or the age on the alcohol intake in the
sample group.
65
4.4.2 Essential fatty acids
4.4.2.1 Linoleic acid
The intake of linoleic acid should account for 2.5% of the total energy intake of an adult.
MEN
For men with a daily energy intake of 2300 kcal the linoleic acid intake should be 6.3g
per day (1 kcal = 0.11g fat).
There is no significant difference in the mean intake of linoleic acid among male
Vietnamese and the reference value.
66
WOMEN
For women with a daily energy intake of 1800 kcal the intake of linoleic acid should be
5g per day (1 kcal = 0.11g fat).
The mean intake of linoleic acid among female Vietnamese is significant higher
than the reference intake.
SEX DIFFERENCE
No significant different in the intake of linoleic acid between the sexes.
4.4.2.2 Alpha-Linolenic acid
The intake of α-linolenic acid should account for 0.5% of the total energy intake of an
adult.
MEN
For men with a daily energy intake of 2300 kcal the α-linolenic acid intake should be 1.3g
per day.
67
The mean intake of α-linolenic acid is in the men group not significantly different
in comparison with the recommended value.
WOMEN
For women with a daily energy intake of 1800 kcal the α-linolenic acid intake should be
1g per day.
The mean intake of α-linolenic acid in the women group is higher compared to
the reference intake. However, the result is not significant.
SEX DIFFERENCE
68
The mean intakes of α-linolenic acid are not significantly different between the
two groups.
4.4.2.3 EPA + DHA
The mean intake of EPA + DHA in the Vietnamese sample group is significantly
higher than the reference value.
69
SEX DIFFERENCE
There is no significant difference in the mean intakes of EPA + DHA between the
males and females in the sample group.
4.4.3 Lipo-soluble vitamins
70
4.4.3.1 Vitamin A
MEN
The mean intake of vitamin A among Vietnamese men is not significantly
different than the reference intake.
WOMEN
Similar result for Vietnamese women. Although, the mean value difference is
much higher in the women group, the result is not significantly higher compared
to the reference value.
SEX DIFFERENCE
71
There is no significant difference in the intake of vitamin A between the male
and female group.
4.4.3.2 Beta-carotene
Recommended intake: 2-4 mg/day for adults
The mean intakes of beta-carotene among Vietnamese men and women are in
the reference range.
SEX DIFFERENCE
There is no significant difference in the intake of beta-carotene between the
sexes.
72
4.4.3.3 Vitamin D
The mean intake of vitamin D in the sample group is 2µg per day, which is
significantly lower than the recommended intake of 20µg per day.
SEX DIFFERENCE
No significant difference in the intake of vitamin D between the men and women
group.
4.4.3.4 Vitamin E
MEN
73
*Reference value for 25 to under 51 years old were used
The mean intake of vitamin E is higher than the reference value among the
Vietnamese men, but not significantly.
WOMEN
*Reference value for 25 to under 51 years old were used
In the women group the mean intake of vitamin E is significantly higher than the
reference value.
SEX DIFFERENCE
74
The male and female group are not significantly different in the intake of vitamin
E.
4.4.3.5 Vitamin K
MEN
*Reference value for 19 to under 51 years old were used
The mean intake of vitamin K is among male Vietnamese higher than the
reference intake, but not significantly higher.
WOMEN
*Reference value for 19 to under 51 years old were used
For female Vietnamese the mean intake of vitamin K is significantly higher than
the reference value.
75
SEX DIFFERENCE
There is no significant difference in the intake of vitamin K between the two
groups.
4.4.4 Water-soluble vitamins
4.4.4.1 Vitamin B1
MEN
76
*Reference value for 25 to under 65 years old were used
The mean intake of vitamin B1 is not significantly different among the male
subjects compared to the reference value.
WOMEN
*Reference value for 25 to under 65 years old were used
Similar result were found for female subjects. No significant difference in the
intake of vitamin K in comparison with the reference intake.
SEX DIFFERENCE
No significant gender differences in the intake of vitamin B1.
77
4.4.4.2 Vitamin B2
MEN
*Reference value for 19 to under 51 years old were used
The mean intake of vitamin B2 in the men group is not significantly different
from the reference value.
WOMEN
*Reference value for 19 to under 51 years old were used
Similar result as in the male group. In the women group the mean intake of
vitamin B2 is also not significantly different compared to the reference value.
SEX DIFFERENCE
No significant gender differences in the intake of vitamin B2.
78
4.4.4.3 Niacin
MEN
*Reference value for 25 to under 51 years old were used
The mean intake of niacin is among Vietnamese men significantly higher than
the reference intake. The result is more than 4 times higher than the reference
value.
WOMEN
*Reference value for 25 to under 51 years old were used
Similar result in the women group. Also Vietnamese women have a significantly
higher intake of niacin compared to the reference value.
SEX DIFFERENCE
79
There is no significant difference in the intake of niacin between the sexes.
4.4.4.4 Pantothenate
The mean intake of pantothenate of the Vietnamese sample group is
significantly lower in comparison with the reference value.
SEX DIFFERENCE
There are no significant gender differences in the intake of pantothenate.
4.4.4.5 Vitamin B6
MEN
80
*Reference value for 19 to under 65 years old were used
In the male group the mean intake of vitamin B6 is higher than the reference
intake. However, the result is not significant.
WOMEN
*Reference value for 19 to under 65 years old were used
Similar result were found for Vietnamese women. In the female group the
mean intake of vitamin B6 is higher compared to the reference value. But again
the result is not significant.
SEX DIFFERENCE
No significant gender differences in the intake of vitamin B6 in the Vietnamese
sample group.
81
4.4.4.6 Biotin
Recommended intake: 30-60 µg/day for adults
The mean intakes of biotin among Vietnamese men and women are in the
reference range.
SEX DIFFERENCE
No significant difference in the intake of biotin between males and females in
the sample group.
4.4.4.7 Folates
The mean intake of folates in the sample group is significantly lower than the
reference value. On average the Vietnamese receive more than 90µg folates
less than the recommended intake.
82
SEX DIFFERENCE
There are no significant gender differences in the intake of folates.
4.4.4.8 Vitamin B12
The mean intake of vitamin B12 among Vietnamese is significantly higher
compared to the reference intake.
SEX DIFFERENCE
There is no significant difference in the intake of vitamin B12 between the
sexes.
83
4.4.4.9 Vitamin C
MEN
In the men group the mean intake of vitamin C is not significantly different than
the reference value.
WOMEN
Similar result were found for the female group. Here, the mean intake of
vitamin C is also not significantly different than the recommended intake.
SEX DIFFERENCE
84
No significant differences in the intake of vitamin C between the two groups.
4.4.5 Mineral nutrients
4.4.5.1 Calcium
The mean calcium intake of the sample group is significantly lower in
comparison to the recommended intake.
SEX DIFFERENCE
85
There are no significant gender differences in the intake of calcium.
4.4.5.2 Potassium
The mean intakes of potassium among Vietnamese men and women are
significantly higher than the reference value.
SEX DIFFERENCE
The mean intakes of potassium are not significantly different between the men
and the women group.
86
4.4.5.3 Magnesium
MEN
*Reference value for 25 to 65 years and older were used
The men sample group consume on average significantly less magnesium than
the recommended amount.
WOMEN
*Reference value for 25 to 65 years and older were used
Similar situation was found for women. The mean intake of magnesium in the
female group is also significantly lower compared to the recommended intake.
SEX DIFFERENCE
87
No significant gender differences in the intake of magnesium in the Vietnamese
sample group.
4.4.5.4 Iron
MEN
*Reference value for 19 to under 51 years old were used
The mean iron intake of male subjects is higher than the reference value.
However, the result is not significant.
WOMEN
*Reference value for 19 to under 51 years old were used
For the female subjects the mean intake of iron is significantly lower than the
reference intake. Vietnamese women have on average a more than 5 mg less
intake of iron than they should have.
SEX DIFFERENCE
88
The mean iron intake in the women group is lower than in the men group,
although the recommended intake for women is higher. However, the result is
not significantly different between the two groups.
4.4.5.5 Zinc
MEN
The mean zinc intake among Vietnamese men is not significantly different
compared to the reference intake.
WOMEN
The women group has a significantly higher intake of zinc in comparison with
the reference value.
89
SEX DIFFERENCE
Although the men have a higher mean intake of zinc than the women, the
result is not significantly different between the two groups.
4.4.5.6 Iodine
*Reference value for 19 to under 51 years old were used
The mean iodine intake of the Vietnamese sample group is significantly lower
than the recommended intake.
SEX DIFFERENCE
90
There are no significant gender differences in the intake of iodine among the
Vietnamese.
4.4.5.7 Cooking salt – Sodium chloride
The mean intake of salt in the sample group is significantly lower than the
reference value.
SEX DIFFERENCE
No significant gender differences in the intake of salt.
4.5 Discussion
4.5.1 Energy and energy delivering nutrients
WOMEN D-A-CH 2015 MEN
w m
Energy1 (kcal) 1515* 1800 2300 1880*
Protein2 (g) 66.1* 48 57 90.1*
1 Reference value for the mean intake of energy in kcal for 25 to under 51 years old adults with a BMI in the normal area and with low physical activity (PAL 1.4) 2 Reference value for 19 to under 51 years old were used
91
Fat3 (g) 56.9 < 59.4 < 75.9 63.9
therefrom SFA4 (g) 24.1 < 19.8 < 25.3 26.7
therefrom MUFA5 (g) 19.2 19.8 - 25.7 25.3 - 32.9 23.1
therefrom PUFA6 (g) 9.3 13.9 - 19.8 17.7 - 25.3 9.2
Cholesterol (mg) 322 300 379.4
Carbohydrates7 (g) 171.1* > 216 > 276 221.9
therefrom Sugar8 (g) 66.1* < 43.2 < 55.2 91.3
Dietary fiber (g) 14.6* 30 14.1*
Alcohol (g) 5.6 < 10 < 20 4.4*
SFA=saturated fatty acids, MUFA=monounsaturated fatty acids, PUFA=polyunsaturated fatty acids
Table 1: The daily intake of energy and energy delivering nutrients among Vietnamese
4.5.1.1 Energy
The mean intake of energy and energy delivering nutrients of the Vietnamese sample
group is represented in Table 1.
The daily intake of energy in kcal among Vietnamese did not meet the reference values
of D-A-CH 2015 with low physical activity. The women with 1515 kcal per day and the
men with 1880 kcal per day, respectively, had a significantly lower intake than the
recommended intake. There was no significant difference in the intake of energy
between the Vietnamese men and women. Neither the sex nor the age played a
significant role in the intake of energy among Vietnamese people.
4.5.1.2 Protein
The protein intake among male and female Vietnamese was significantly higher in
comparison with the reference intake. Vietnamese men had a protein intake of
90.1g/day which is more than 1.5 times higher than the reference intake of 57g/day.
Also the Vietnamese women had a significantly higher intake of protein with 66.1g/day
3 Fat intake should be maximum 30% of total energy intake of an adult 4 Intake of SFA should be maximum 10% of total energy intake 5 Intake of MUFA should account for 10-13% of total energy intake 6 Intake of PUFA should account for 7-10% of total energy intake 7 Carbohydrate intake should account for more than 50% of total energy intake 8 Intake of sugar should not be more than 10% of total energy intake
92
which also did not meet the reference value of 48g/day. The intake of protein among
Vietnamese men was significantly higher than among the women. That means that the
factor sex had significant influence on the intake of protein amongst Vietnamese. The
age had no significant influence on the protein intake.
4.5.1.3 Fat
The Vietnamese intake of fat met the reference intake. The fat intake should not be
higher than 30% of the total energy intake which was the case amongst Vietnamese men
and women. The men had a fat intake of 63.9g per day and the women an intake of
56.9g per day. However, the result was in both group not significantly different from the
reference value. Also there was no significant difference in the intake of fat between the
male and female Vietnamese.
The intake of saturated fatty acids among Vietnamese men was 26.7g/day which was
higher than the reference intake. A similar result was shown among Vietnamese women
with an intake of 24.1g/day which was as well higher compared to the reference value.
However, both results were not significant. There was also no significant difference in
the intake of saturated fatty acids between the men and the women.
The intakes of monounsaturated fatty acids among both Vietnamese men and women
were lower than the reference intakes. The men had an intake of 23.1g per day and the
women 19.2 g per day. The intakes of monounsaturated fatty acids were not significantly
different among male and female Vietnamese.
The Vietnamese also did not meet the reference intake of polyunsaturated fatty acids.
The men with an intake of 9.2g/day and the women with 9.3g/day, respectively, were
lower than the recommended intake. There was no significant difference in the intake
of polyunsaturated fatty acids between Vietnamese men and women.
The reference intake for cholesterol is maximum 300mg per day for both men and
women. The cholesterol intake of Vietnamese men and women were both higher in
comparison with the reference value. Neither sex nor age had a significant influence on
the intake of cholesterol among the Vietnamese.
93
4.5.1.4 Carbohydrates
The carbohydrate intake should account for more than 50% of the total energy intake.
The Vietnamese men with an intake of 221.9g per day and the women with 171.1g per
day were both lower than the reference value. The result for the Vietnamese women
was significantly lower than the reference intake. Again, there was no significant
difference between the male and female intake of carbohydrates among the
Vietnamese.
The sugar intake of Vietnamese people were for both males and females higher than the
recommended intake. The women with an intake of 66.1g/day had a significantly higher
intake than the maximum value of 43.2g/day. The intakes of sugar were not significantly
different between Vietnamese men and women.
4.5.1.5 Dietary fiber
Both Vietnamese men and women had a significantly lower intake of dietary fiber
compared to the reference value. The men had an intake of 14.1g per day and the
women 14.6g per day. The reference intake is amounted to 30g per day. The Vietnamese
ate less than half of the recommended intake of dietary fiber.
4.5.1.6 Alcohol
For men the maximum tolerable amount of alcohol is 20g/day. The male Vietnamese
had an intake of 4.4g per day which was significantly lower than the maximum value.
For women the maximum tolerable amount of alcohol is at 10g/day. The female
Vietnamese had an alcohol intake of 5.6g per day which was also lower than the
maximum value, but not significant. There was no significant difference in the intake of
alcohol between Vietnamese men and women.
4.5.2 Dietary energy intake/ energy proportion
The ideal distribution of the main nutrient for energy delivery should be according to
the reference values for nutrient uptake from D-A-CH like this:
Protein should make up to 10-15% of the total energy intake
Fat should not account for more than 30% of the total energy intake
Carbohydrates should be more than 50%, ideal up to 55-60% of the total energy
94
Figure 23: Dietary energy intake according to D-A-CH 2015
In the sample group the distribution looks like this:
The mean energy intake in the sample group is amount to 1663 kcal/day.
So the mean protein intake is 76g per day which are approximately 312 kcal (1g protein
= 4.1 kcal). This would make up to 19% of the mean total energy intake of the
Vietnamese sample group.
The fat intake is 60g per day which are 558 kcal (1g fat = 9.3 kcal). Fat would make up to
34% of the total energy intake in the sample group.
The mean intake of carbohydrates is 192g which are 787 kcal (1g carbohydrates = 4.1
kcal). This means carbohydrates would make up to 47% of the total energy intake.
Figure 24: Energy proportion in the sample group
Protein
FatCarbohydrates
DIETARY ENERGY INTAKE
Protein
Fat
Carbohydrates
ENERGY PROPORTIONIN THE SAMPLE GROUP
95
The results showed that the energy intake in the sample group was lower than the
reference value for both men and women. However, the distribution of the main
nutrients for energy delivery varied from the guidelines. The proportion of protein with
19% and fat with 34% of the total energy intake in the diet of the sample group were
both higher than the recommended percentage of total energy intake. And the
percentage of carbohydrates was with 47% of the total energy intake much lower than
the recommended intake.
To sum it up, the Vietnamese’s energy intake was significantly lower than the reference
value. However, the intake of fat and protein were among Vietnamese men and women
much higher compared to the recommended intakes. The Vietnamese also did not meet
the reference values for carbohydrates for nutrient uptake from D-A-CH 2015. An
improvement of the energy proportion in the Vietnamese diet is here very desirable.
4.5.3 Essential fatty acids
WOMEN D-A-CH 2015 MEN
w m
Linoleic acid9 (g) 7* 5 6.3 6.9
α-Linolenic acid10 (g) 1.2 1 1.3 1.3
EPA (mg) 237.9 - 176.8
DHA (mg) 345.1 - 279.9
EPA + DHA (mg) 583* 250 456.8*
EPA=eicosapentaenoic acid, DHA=docosahexaenoic acid
Table 2: The daily intake of essential fatty acids among Vietnamese
4.5.3.1 Linoleic acid
The daily intake of linoleic acid among Vietnamese men with 6.9g met the reference
value of 2.5% of the total energy intake. For Vietnamese women the linoleic acid intake
of 7g per day was actually significantly higher than the recommended intake. But in
9 Intake of linoleic acid should account for 2.5% of total energy of an adult 10 Intake of α-linolenic acid should account for 0.5% of total energy of an adult
96
comparison, the male and female linoleic acid intakes were not significantly different
from each other.
4.5.3.2 Alpha-Linolenic acid
The α-linolenic acid intakes of the Vietnamese men and women met the recommended
value of 0.5% of the total energy intake. The men had an intake of 1.3g/day. The women
had an α-linolenic acid intake of 1.2g/day which was higher than the reference intake.
However, the result had no significant evidence.
4.5.3.3 EPA + DHA
The Vietnamese had a quite high intake of eicosapentaenoic acid and docosahexaenoic
acid. The reference value of EPA + DHA is at 250mg per day for men and women. Both,
the men with an intake of 456.7mg/day and the women with 583mg/day had a
significant higher intake in comparison with the recommended intake. The two groups
compared had no significant gender differences in the intake.
4.5.4 Lipo-soluble vitamins
WOMEN D-A-CH 2015 MEN
w m
Vitamin A retinol equivalents11
(mg)
1.4 0.8 1 1.1
β-carotene (mg) 3.2 2 - 4 2.5
Vitamin D calciferol (µg) 2.2* 20 1.6*
Vitamin E tocopherol
equivalents12 (mg)
19.2* 12 14 16.9
Vitamin K phyllochinon13 (µg) 134.7* 60 70 87.8
Table 3: The daily intake of lipo-soluble vitamins among Vietnamese
11 1mg retinol equivalent= 1mg retinol= 6mg all-trans-β-carotene= 12mg other provitamin-A-carotenoids= 1,15mg all-trans-retinyl acetate= 1,83mg all-trans-retinyl palmitate 12 1mg RRR-α-tocopherol equivalent= 1mg RRR-α-tocopherol= 1,1mg RRR-α-tocopheryl acetate= 2mg RRR-β-tocopherol= 4mg RRR-γ-tocopherol= 100mg RRR-δ-tocopherol= 3,3mg RRR-α-tocotrienol= 1,49mg all-rac-α-tocopheryl acetate; Reference value for 25 to under 51 years old were used 13 Reference value for 19 to under 51 years old were used
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4.5.4.1 Vitamin A (Retinol)
Vietnamese men and women met the reference intake of vitamin A retinol equivalents.
The women had a higher intake with 1.4mg/day than the men with 1.1mg/day.
However, the difference was not statistically significant.
4.5.4.2 Beta-carotene
Both, male and female Vietnamese had an adequate β-carotene intake which was in the
reference area of 2-4mg per day. The intakes of the men and women in comparison had
no significant difference.
4.5.4.3 Vitamin D (Calciferol)
The Vietnamese had a vitamin D intake of 2µg per day, which is far below the
recommended intake of 20µg vitamin D per day. The vitamin D intake of an adult with
common food add up to 2-4µg vitamin D per day, which is not enough for adequate
nutritional requirement. The supply should be ensured additional to the dietary intake
with endogen synthesis and/or with dietary supplements (Anon 2015). Furthermore,
there were no significant gender differences in the intake of vitamin D among
Vietnamese people.
4.5.4.4 Vitamin E (Tocopherol)
The daily intake of vitamin E tocopherol equivalents among Vietnamese men was
adequate compared to the reference value. Vietnamese women with a vitamin E intake
of 19.2mg per day had a significant higher intake compared to the recommended intake
of 12mg per day. However, the intakes of vitamin E among the males and females were
not significantly different.
4.5.4.5 Vitamin K (Phyllochinon)
The vitamin K intake was for both sexes above the references values for daily intake. But
the intake of vitamin K among female Vietnamese was with 134.7µg/day even more
than double as high as the reference value with 60µg/day. For the vitamin K intake there
is no defined upper limit therefore it can be assumed that the intake of vitamin K among
Vietnamese was satisfying. However, there was no significant difference in the vitamin
K intake between the men and the women.
98
4.5.5 Water-soluble vitamins
WOMEN D-A-CH 2015 MEN
w m
Vitamin B1 thiamin14 (mg) 1.1 1 1.2 1.5
Vitamin B2 riboflavin15 (mg) 1.1 1.1 1.4 1.3
Vitamin B3 niacin
equivalents16 (mg)
42.6* 12 15 60*
Vitamin B5 pantothenic
acid (mg)
3.8* 6 5
Vitamin B6 pyridoxine17
(mg)
1.5 1.2 1.5 1.8
Vitamin B7 biotin (µg) 46 30 - 60 51.3
Vitamin B9 folate
equivalents18 (µg)
215.5* 300 196.1*
Vitamin B12 cobalamin (µg) 5.5* 3 4.5*
Vitamin C ascorbic acid
(mg)
99.2 95 110 113.4
Table 4: The daily intake of water-soluble vitamins among Vietnamese
4.5.5.1 Vitamin B1 (Thiamin)
The daily intake of vitamin B1 among the Vietnamese was above the reference value.
There was also no significant difference in the intake of vitamin B1 between the
Vietnamese men and women.
4.5.5.2 Vitamin B2 (Riboflavin)
The vitamin B2 intake of Vietnamese people was also satisfying. Vietnamese men have
a lower intake of vitamin B2 than the reference intake, but the result was not significant.
14 Reference value for 25 to under 65 years old were used 15 Reference value for 19 to under 51 years old were used 16 1mg niacin equivalent= 1mg niacin= 60mg tryptophan; Reference value for 25 to under 51 years old were used 17 Reference value for 19 to under 65 years old were used 18 1µg folate equivalent= 1μg natural food folate= 0,5μg synthetic folic acid (pteroylmonoglutamic acid)
99
There were as well no significant gender differences in the intake of vitamin B2 among
the Vietnamese.
4.5.5.3 Vitamin B3 (Niacin)
The daily intake of vitamin B3 niacin equivalents was for male and female Vietnamese
significantly higher than the recommended intake. The men had a niacin intake of 60mg
per day and the women of 42.6mg per day. The EFSA (European Food Safety Authority)
has defined a tolerable total intake of vitamin B3. Niacin exists in vegetables as nicotinic
acid and in animal products as nicotinamide. For nicotinic acid the tolerate amount is
10mg/day and for nicotinamide it is 900mg/day. The main providers of vitamin B3 niacin
are meat, coffee and bread (Anon 2015). The high intake of protein could be one reason
for the high intake of niacin among Vietnamese. However, the niacin intakes of the
Vietnamese men and women were not significantly different.
4.5.5.4 Vitamin B5 (Pantothenic acid)
The recommended intake of vitamin B5 is for men and women 6mg per day. The vitamin
B5 intake was for male and female Vietnamese lower compared to the reference value.
The Vietnamese women had with an intake of 3.8mg/day even a significantly lower
intake than the recommended 6mg/day. Men and women in comparison had no
significant difference in the intake of pantothenic acids.
4.5.5.5 Vitamin B6 (Pyridoxine)
Both Vietnamese men and women had an adequate intake of vitamin B6. There was also
no significant difference in the vitamin B6 intake between the male and female
Vietnamese.
4.5.5.6 Vitamin B7 (Biotin)
The daily intake of biotin was among Vietnamese men and women in the reference area
of 30-60µg per day. The men with a biotin intake of 51.3µg/day and women with
46µg/day were not significantly different in the intake of biotin.
4.5.5.7 Vitamin B9 (Folate)
The reference value for the intake of folate equivalents is 300µg per day. The intake of
folate equivalents was for both male and female Vietnamese significantly lower than the
100
reference intake. The men had an intake of 196.1µg per day and the women of 215.5µg
per day. Studies showed that with a daily intake of approximately 200µg folate
equivalents an adequate nutritional requirement of folate can be achieved for an adult.
The recommended folate intake of 300µg per day includes already a safety margin (Anon
2015).
4.5.5.8 Vitamin B12 (Cobalamin)
The intake of vitamin B12 for Vietnamese men with 4.5µg/day and Vietnamese women
with 5.5µg/day was significantly higher compared to the reference value of 3µg per day
for an adult. With the common diet of European people the intake of vitamin B12 is far
above the reference intake (Anon 2015). However, there was no significant difference in
the vitamin B12 intake between the Vietnamese men and women.
4.5.5.9 Vitamin C (Ascorbic acid)
The intake of vitamin C among Vietnamese was satisfying. The males and females had
both a vitamin C intake above the reference value. Therefore, an adequate nutritional
supply could be assured. The intakes of Vietnamese men and women in comparison
were not significantly different from each other.
4.5.6 Mineral nutrients
WOMEN D-A-CH 2015 MEN
w m
Calcium (mg) 525* 1000 533.3*
Potassium (mg) 2256.2* 2000 2306.7*
Magnesium19 (mg) 247.7* 300 350 279.6*
Iron20 (mg) 9.5* 15 10 10.5
Zinc (mg) 9* 7 10 11.1
Iodine21 (µg) 106.6* 200 89.3*
Table 5: The daily intake of mineral nutrients among Vietnamese
19 Reference value for 25 to 65 years and older were used 20 Reference value for 19 to under 51 years old were used 21 Reference value for 19 to under 51 years old were used
101
4.5.6.1 Calcium
The daily intake of calcium among Vietnamese was significantly lower than the
recommended intake of 1000mg per day for men and women. The men had a calcium
intake of 533.3mg/day and the women of 525mg/day. Since our bones store calcium in
case of a nutritional under-supply it can be released into our blood stream to maintain a
normal calcium concentration in serum. In case of long-lasting nutritional under-supply
the situation becomes more critical because this can lead to bone mass reduction (Anon
2015).
4.5.6.2 Potassium
The Vietnamese had a potassium intake above the reference value of 2000mg per day.
Both the male and female Vietnamese had an intake which was significantly higher
compared to the reference intake. A high intake of potassium is effective for lowering
the blood pressure (Anon 2015).
4.5.6.3 Magnesium
Both Vietnamese men and women did not meet the reference value for magnesium.
The men with an intake of magnesium of 279.6mg/day and the women of 247.7mg/day
were both significantly lower than the recommended intake of 350mg/day for men and
300mg/day for women. Furthermore, there was no significant difference in the
magnesium intake between the male and female Vietnamese.
4.5.6.4 Iron
Vietnamese men had an adequate intake of iron, which is above the reference value.
For Vietnamese women the situation was more critical. The iron intake among the
females with 9.5mg per day was significantly lower than the recommended intake of
15mg per day.
4.5.6.5 Zinc
The Vietnamese had an adequate intake of zinc. The women had a zinc intake of 9mg
per day which was even significantly higher in comparison with the reference value of
7mg per day. Although the men had a higher intake of zinc compared to the women, the
result was not statistically significant.
102
4.5.6.6 Iodine
The daily intake of iodine among Vietnamese was significantly lower than the reference
value of 200µg per day. The intake among the men was only 89.3µg/day and among the
women 106.6µg/day. In Austria the iodine intake is linked with the salt intake. One
reason for the low intake of iodine among Vietnamese could be the missing entries of
salt in the interviews. The author did not always included salt as an ingredient.
4.5.6.7 Cooking salt - Sodium chloride
The reference value for salt is maximum 6g per day which also ensures an adequate
sodium supply. A higher intake of salt is associated with negative effects (Anon 2015).
The daily intake of salt among the Vietnamese was 4.7g per day which was significantly
lower compared to the reference intake of 6g per day. Again, one reason for that could
be the missing entries of salt. Furthermore, there was no significant difference in the
salt intake between Vietnamese men and women.
4.6 Austrian diet vs. Vietnamese diet
In the next chapter the data from the study is been compared to the latest Nutritional
Survey of Austria in 2012. For better comparison only one age group (25 to 50 years old)
from the Austrian Nutritional Survey has been taken into consideration (Elmadfa 2012).
4.6.1 Energy percentage of main nutrients and alcohol
Austrian Vietnamese D-A-CH 2015
Protein (E%) 15 19 10-15
Fat (E%) 36 34 < 30
Carbohydrates (E%) 46 47 > 50
Alcohol (E%) 3 - -
E%=percentage of energy
Table 6: Intake of main nutrients and alcohol in energy percentages among Austrian and Vietnamese
The intake of protein among Austrians was clearly lower than among Vietnamese
people. In return the fat intake of the Austrians was higher than of the Vietnamese. The
intakes of carbohydrates were nearly the same.
103
The Vietnamese had a higher protein intake than the reference intake of D-A-CH 2015.
The intakes of fat were for both Austrian and Vietnamese too high, and the carbohydrate
intake for both too low compared to the recommended intake.
4.6.2 Lipo-soluble vitamins
4.6.2.1 Women
Austrian Vietnamese D-A-CH 2015
Vitamin A retinol equivalents
(mg)
1.3 1.4 0.8
β-carotene (mg) 3.4 3.2 2 - 4
Vitamin D calciferol (µg) 2.8 2.2 20
Vitamin E tocopherol
equivalents (mg)
13 19.2 12
Vitamin K phyllochinon (µg) 102 134.7 60
Table 7: Intake of lipo-soluble vitamins among Austrian and Vietnamese women
The intakes of vitamin A and β-carotene between Austrian and Vietnamese women were
nearly the same. The Austrian women had a higher intake of vitamin D, in return the
vitamin E and vitamin K intakes were clearly lower in comparison with the Vietnamese
women.
The intakes of vitamin A, vitamin E and vitamin K for both Austrian and Vietnamese
women were above the reference value. The β-carotene intake was in the reference
range and the vitamin D intake was far below the recommended intake.
4.6.2.2 Men
Austrian Vietnamese D-A-CH 2015
Vitamin A retinol equivalents
(mg)
1 1.1 1
β-carotene (mg) 3.4 2.5 2 - 4
Vitamin D calciferol (µg) 3.6 1.6 20
Vitamin E tocopherol
equivalents (mg)
13 16.9 14
104
Vitamin K phyllochinon (µg) 89 87.8 70
Table 8: Intake of lipo-soluble vitamins among Austrian and Vietnamese men
The intakes of vitamin A and vitamin K were nearly the same between Austrian and
Vietnamese men. Whereas the intakes of β-carotene and vitamin D were among
Austrian men clearly higher than among Vietnamese men. The intake of vitamin E was,
like for women, among Austrian men lower compared to the intake of Vietnamese men.
The vitamin E intake of Vietnamese men was far above the reference intake, whereas
the intake of Austrian men was below. Both had an intake of vitamin K which was
satisfying. The intake of vitamin D was similarly to the women far below the reference
value.
4.6.3 Water-soluble vitamins
4.6.3.1 Women
Austrian Vietnamese D-A-CH 2015
Vitamin B1 thiamin (mg) 1.1 1.1 1
Vitamin B2 riboflavin (mg) 1.2 1.1 1.1
Vitamin B3 niacin
equivalents (mg)
27 42.6 12
Vitamin B5 pantothenic acid
(mg)
4 3.8 6
Vitamin B6 pyridoxine (mg) 1.5 1.5 1.2
Vitamin B7 biotin (µg) 42 46 30 - 60
Vitamin B9 folate
equivalents (µg)
216 215.5 300
Vitamin B12 cobalamin (µg) 4 5.5 3
Vitamin C ascorbic acid (mg) 116 99.2 95
Table 9: Intake of water-soluble vitamins among Austrian and Vietnamese women
The intake of niacin was among Austrian women clearly lower than among Vietnamese
women. Also the vitamin B12 intake of Austrian women was below the intake of
Vietnamese women. Only the intake of vitamin C among Austrian women was higher in
105
comparison to Vietnamese women.
For both Austrian and Vietnamese women the intakes of niacin, vitamin B12 and vitamin
C were above the reference value. Whereas the pantothenate and folate intakes were
for both lower than the reference intake. For all the other water-soluble vitamins the
recommended intakes were reached among both Austrian and Vietnamese women.
4.6.3.2 Men
Austrian Vietnamese D-A-CH 2015
Vitamin B1 thiamin (mg) 1.2 1.5 1.2
Vitamin B2 riboflavin (mg) 1.4 1.3 1.4
Vitamin B3 niacin
equivalents (mg)
35 60 15
Vitamin B5 pantothenic acid
(mg)
4.6 5 6
Vitamin B6 pyridoxine (mg) 2 1.8 1.5
Vitamin B7 biotin (µg) 41 51.3 30 - 60
Vitamin B9 folate
equivalents (µg)
197 196.1 300
Vitamin B12 cobalamin (µg) 5.3 4.5 3
Vitamin C ascorbic acid (mg) 110 113.4 110
Table 10: Intake of water-soluble vitamins among Austrian and Vietnamese men
The intakes of niacin and biotin of Austrian men were clearly lower than of Vietnamese
men. All the other intakes of water-soluble vitamins were among Austrian and
Vietnamese men nearly the same.
For both Austrian and Vietnamese men the intakes of niacin and vitamin B12 were above
the reference value. The intakes of pantothenate and folate were for both below the
recommended intake of D-A-CH. The intakes of the rest of the water-soluble vitamins
met the reference values for both Austrian and Vietnamese men.
106
4.6.4 Mineral nutrients
4.6.4.1 Women
Austrian Vietnamese D-A-CH 2015
Calcium (mg) 838 525 1000
Potassium (mg) 2632 2256.2 2000
Magnesium (mg) 329 247.7 300
Iron (mg) 10.9 9.5 15
Zinc (mg) 9.7 9 7
Iodine (µg) 130 106.6 200
Table 11: Intake of mineral nutrients among Austrian and Vietnamese women
The intakes of all mineral nutrients were for Austrian women higher than for Vietnamese
women.
In comparison with the D-A-CH reference values the intakes of calcium, iron and iodine
were among both Austrian and Vietnamese women below the reference intake. The
intakes of potassium and zinc were for both above the recommended intake. The
Austrian women met the reference intake of magnesium, whereas the Vietnamese
women had a lower magnesium intake compared to the reference value.
4.6.4.2 Men
Austrian Vietnamese D-A-CH 2015
Calcium (mg) 881 533.3 1000
Potassium (mg) 2768 2306.7 2000
Magnesium (mg) 334 279.6 350
Iron (mg) 11.8 10.5 10
Zinc (mg) 11.4 11.1 10
Iodine (µg) 143 89.3 200
Table 12: Intake of mineral nutrients among Austrian and Vietnamese men
Similar situation in the intake of mineral nutrients among the men as for the women.
The mineral nutrients intakes of Austrian men were all-around clearly higher than for
Vietnamese men.
107
Both Austrian and Vietnamese men had lower intakes of calcium and magnesium than
the recommended intake. The intakes of potassium, iron and zinc were for both above
the reference value of D-A-CH. The iodine intake was among both Austrian and
Vietnamese men below the reference value, but the intake of Vietnamese men did not
even reach half of the recommended intake.
108
109
5 Summary
Considering the results of the conducted study and the literature review, the author of
this thesis considered the answers to the four initial research questions of this thesis to
be the following:
Research question 1: How is the nutritional status of the population in Vietnam?
The latest General Nutrition Survey of Vietnam from 2009-2010 showed that the
nutritional status of children under five years old is still very critical. In 2010, 17.5% of
the children under 5 were underweight, 29.3% were stunted and 7.1% were wasted.
Critical regions with the highest prevalence were the Northern Midlands and Mountain
areas, the North Central area and the Central Coastal area, and the Central Highlands.
The lowest levels were found in the Red River Delta and the South East areas. Risk factors
which have shown a strong association to these diseases were poor household wealth,
rural households, low maternal height, low maternal BMI, low maternal education and
low household dietary diversity. From 2000 to 2010, the prevalence of underweight and
stunting had significantly decreased. However, there was no significant evidence of
improvement for the prevalence of wasting in children under 5 years. The prevalence of
wasting in Vietnam is considered at medium level by the World Health Organization.
While the prevalence of undernutrition is decreasing, overweight and obesity has
become more and more a national concern in Vietnam. The prevalence of overweight
and obesity in children under 5 was found at 5.6%. In urban areas the prevalence of
overweight/obesity was even higher at 6.5%.
The nutritional status of children 5 to 19 years old in Vietnam is not better. The
prevalence of underweight in children 5-19 years old was at 24.2%, the prevalence of
stunting was at 23.4% and the prevalence of wasting was at 16.8%. The prevalence of
underweight and wasting in children 5-19 years old was even higher than in children
under 5. Also the level of overweight and obesity was higher with 8.5%. Risk factors for
overweight/obesity were high maternal BMI and high maternal education. The data
indicated that in Vietnam in the future the trend of overweight and obese children and
adolescents will be increasing especially in large cities.
Chronic energy deficiency is one of the main health problems for adults in Vietnam. In
110
2010, the prevalence of CED in adults was found at 17.2%. The CED level in women was
at 18.5% which was significantly higher than the level for men which was at 15.8%. The
highest levels of CED were found in adults under 25 years and over 55 years old.
However, comparing the number of CED from 2000 with 2010, it was noted that the CED
level decreased in almost all age groups. The prevalence of overweight and obesity in
adults in Vietnam was found at 5.6%. The age group from 55 to 59 years old had the
highest overweight and obesity level. The region with the highest overweight/obesity
level was in the South East. The prevalence there was 10.7%. Overweight and obesity
was significantly more prevalent in urban areas than in rural areas.
High focus should also be on the time period of women during pregnancy through the
first two years of the child’s life because deficiencies during this critical period are
leading to lifelong damages of the child. In 2010, the prevalence of chronic energy
deficiency in mothers with children under 5 years old was found at 20.2%. The highest
level of CED was in young mothers aged 15-19 years old. From 2000 to 2010, the
prevalence of CED in mothers had decreased slowly with an average reduction rate of
0.65% per year. Among mothers with children under 5 years old the trend of being
overweight and obese was as well clearly increasing over the years. Compared to 2000,
the prevalence of overweight/obesity in mothers had more than doubled from 3% to
6.4% in 2010.
Over the years there was a primary change in the food consumption of the Vietnamese
population which included the increased amount of food from animal sources. These
changes were leading further to a change in the dietary compositions of the Vietnamese.
The increased consumption of animal protein in the diet was observed. There were
significant differences in the consumption of protein between urban and rural regions.
Also the daily intake of oil and fat had gradually increased over the past decades.
Another remarkable change happened in the dietary energy intake. The proportion of
total energy intake had changed from 1985 with 11.2% from protein, 6.2% from fat and
82.6% from carbohydrates to 15.9% from protein, 17.8% from fat and 66.3% from
carbohydrates by 2009. The current ratio is considered to be relatively ideal. These
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changes in dietary patterns among Vietnamese showed that the food consumption in
Vietnam had improved greatly.
Research question 2: What are the changes in food habits among immigrants?
When people move to a new country they may underlie the process of dietary
acculturation. Dietary acculturation is the process by which members of a migrating
group adopt the food choices and eating habits of their new environment. Dietary
acculturation can have both positive and negative dietary changes which leads to
positive and negative health consequences. Many factors influencing the dietary
acculturation which result in many different patterns and habits of food intake. There
are socioeconomic, demographic, cultural, psychological and environmental factors.
Studies showed that the factors longer residence in the host country, high education
and income of the immigrant, employment outside the home result in a higher exposure
to the host culture. Also being married, having young children and fluency with the host
language play a major role to the great extent of exposure. “Daily life” factors like
exposure to a new food supply, unavailability of traditional foods and ingredients,
expensive traditional foods and time-consuming preparation of traditional dishes are
one of the most common reason for dietary acculturation among immigrants. There are
three different ways of dietary acculturation. First is when the immigrant maintains his
or her traditional food habits. Secondly the immigrant fully adopts the host environment
foods and eating patterns or third, there will be a biculturalism, which is an
incorporation of the host foods and eating habits into their own diet while maintaining
some traditional dietary practices.
In another model from Koctürk the food is separated in three main groups with different
degrees of importance according to their role in a dish and/or meal. There are staple
foods which are the principal component of a meal. Staple foods are for example bread,
rice or potatoes. The staple food is the most important element in a dish for the survival
of a food tradition. After staple foods follow the complements which are one or several
items from four food groups. These four food groups are meat/fish/eggs, milk/cheese,
vegetables and legumes. While a staple food should not be substitute, complementary
foods can be exchanged with other items without ruining the whole food culture. And
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last on the third place come the accessory foods. Accessories are foods including fats,
herbs and spices, sweets, nuts, fruits and drinks. Accessory foods are at least important
and can be substituted according to taste. Changes in food habits start with the
accessory foods. This is because they can be exchanged without ruining a whole food
tradition. In a diet, the change begins with incorporation of new accessories then further
with different complementary foods and finally with the exchange of new staple foods.
The attachment of traditional staple foods is the strongest which is why it is the last food
item that changes in a diet if it changes at all.
Dietary acculturation in Western countries is associated with negative choices in the
dietary pattern like high consumption of fat and sugar, low consumption of fruits and
vegetables in the diet, lower physical activity, higher Body Mass Index and bigger portion
sizes for examples. Such changes in food habits can lead to an increasing risk of chronic
diseases including obesity, hypertension, cardiovascular diseases, type 2 diabetes
mellitus, metabolic syndrome, mental diseases and even cancer among immigrants.
High attention should be given to immigrant women who had according to several
studies adopt several unhealthy food habits to their traditional diet such as high
consumption of fat and sugar snacks and drinks, and as well more fast foods. The main
reasons of this negative acculturation are different barriers such as high prices of healthy
food, easier access to highly produced foods, low nutritional knowledge, unavailability
of traditional foods and ingredients, uncertainty towards new foods and as well
convenient and affordable fast food in the host country. Female migrants need specific
attention due to their reproductive role and as well due to their role in purchasing and
preparing the family meals which have a strong impact on the dietary practices and
health behavior of the whole family.
Research question 3: What are the daily intakes of energy and other nutrients look like
among Vietnamese living in Austria?
A study has been conducted to analyze the diet of in Austrian living Vietnamese. 42
subjects (17 male, 25 female) did respectively 2 times a 24h-recall interview. With the
nutrition program GloboDiet the interviews were captured and evaluated. Statistical
analysis has been made with SPSS Statistics. The results and outcomes were compared
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with the recommendation of D-A-CH 2015.
The daily intake of energy in kcal among Vietnamese did not meet the reference values
at all. The women with 1515 kcal per day and the men with 1880 kcal per day had
respectively a significantly lower intake than the recommended intake. The protein
intake was among male and female Vietnamese significantly higher in comparison with
the reference intake. Vietnamese men had a protein intake of 90.1g/day. Also the
Vietnamese women had a significantly higher intake of protein with 66.1g/day. The
intake of protein was among Vietnamese men significantly higher than among the
women. That means that the factor gender had significant influence on the intake of
protein amongst Vietnamese. The Vietnamese intake of fat met the reference intake.
The intake of saturated fatty acids among Vietnamese men was 26.7g/day which was
higher than the reference intake. A similar result was shown among Vietnamese women
with an intake of 24.1g/day which was as well higher compared to the reference value.
However, both results were not statistically significant. The cholesterol intake of
Vietnamese men and women were as well for both higher in comparison with the
reference value. The Vietnamese men with an intake of 221.9g carbohydrates per day
and the women with 171.1g per day were both lower than the reference value for
carbohydrate intake. But only the result for the Vietnamese women was significantly
lower than the reference intake. The sugar intake of Vietnamese people was for males
and females both higher than the recommended intake. Again, only the women had a
significantly higher intake than the reference value. Both Vietnamese men and women
had a significantly lower intake of dietary fiber compared to the reference value.
The comparison of the dietary energy intake of the Vietnamese sample group with the
recommendation of D-A-CH showed that the energy intake among Vietnamese was
lower than the reference value for both men and women. However, the distribution of
the main nutrients for energy delivery varied from the guidelines. The proportion of
protein with 19% and fat with 34% of the total energy intake in the diet of the sample
group were both higher than the recommended percentage of total energy intake. And
the percentage of carbohydrates was with 47% of the total energy intake much lower
than the recommended intake. An improvement of the energy proportion in the
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Vietnamese diet is here very desirable.
The daily intakes of lipo-soluble vitamins among Vietnamese men and women were for
all vitamins, except for one, above the reference values. Only the vitamin D intake did
not meet the reference value. However, the vitamin E and vitamin K intakes among
female Vietnamese were significantly higher than the recommended intakes. The
Vietnamese had a significantly higher intake of the water-soluble vitamin B3 than the
reference value which can be associated with the high intake of protein. Furthermore,
the intake of vitamin B5 was quite low amongst Vietnamese. But only the vitamin B5
intake of Vietnamese women was significantly lower. The vitamin B9 intakes were for
both male and female Vietnamese significantly lower than the recommended intakes.
In return were the intakes of vitamin B12 for both significantly higher.
The daily intakes of mineral nutrients among Vietnamese looked more critical. The
intakes of calcium, magnesium and iodine of both Vietnamese men and women were
significantly below the reference values. For female Vietnamese the intake of iron was
also significantly lower than the reference value. Only the intake of potassium was
among male and female Vietnamese significantly above the recommended intake. The
Vietnamese women had as well a significantly higher intake of zinc compared to the
recommended intake.
Research question 4: How is the Vietnamese diet in comparison with the Austrian diet?
The comparison of the diet from in Austria living Vietnamese with the Austrian diet
revealed some differences but also many similarities. First, the dietary energy intake. In
the Vietnamese diet the protein intake made up a big percentage of the total energy
intake. In the Austrian diet the fat intake was more dominant. The carbohydrate intake
played for both Vietnamese and Austrians rather an underpart. The intake of lipo-
soluble vitamins looked in Vietnamese and Austrian people quiet similar. Vietnamese
men and women had a quiet high intake of the water-soluble vitamin B3 which could be
explained by the high intake of protein in their diet. Furthermore, Austrian and
Vietnamese had both low intakes of vitamin B5 and vitamin B9 compared to the
reference value. This is counted for both men and women. The intake of mineral
nutrients showed a big difference in the diet of Austrian and Vietnamese people. The
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Austrian had for all mineral nutrients a clearly higher intake in comparison with the
Vietnamese. This result is counted for men and women. In detail, the intake of calcium
was for both Austrian and Vietnamese low, however, the calcium intake of the
Vietnamese was much lower. The magnesium intake was also for both low, but for the
Austrian it only concerned the men and for the Vietnamese both men and women were
affected. In addition, the intake of iron was among Vietnamese and Austrian women
below the recommended intakes.
To sum it up, it is hard to say which diet is healthier than the other. Every form of diet
has its critical nutrients and risk factors which should be considerate. On the other hand,
it is likely the Vietnamese who are living in Austria have already acculturated to the
Austrian diet which makes a comparison obsolete.
5.1 Conclusion
The diet of Vietnamese immigrants in Austria is compared to the Vietnamese population
in Vietnam much better. Nutritional diseases like underweight, stunting and wasting do
not play a role in Austria. In Austria, the main health concerns are the high prevalence
of overweight, low physical activity, high consumption of meat and meat products and
the high intake of saturated fatty acids, sugar and salt. It is the high energy intake on the
one hand and the low physical activity on the other hand what makes this eating
behavior more than critical. Observing the food habits of Vietnamese immigrants in
Austria, it is noticeable that the Vietnamese immigrants have adopted some eating
habits of the Austrian people. There are many similarities between the diets. The diet of
Vietnamese immigrants living in Austria is more similar to the Austrian diet compared
to the diet of the population in Vietnam. For further results, the diet of Vietnamese
immigrants in Austria should be observed on regularly basis to see the development of
their food habits and eating patterns, and as well to prevent following health
consequences.
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